O'Halloran et al reported the Nonunion Risk Determination (NURD) score for evaluating a patient with a tibial fracture. It can help to identify a patient at increased risk for nonunion. The authors are from the University of Maryland in Baltimore.
Patient selection: tibial fracture
Parameters:
(1) percent cortical contact
(2) ASA status from 1 to 3
(3) sex
(4) specific types of fracture
(5) closed vs open fracture
(6) chronic disease (HIV, hepatitis C, diabetes mellitus)
(7) compartment syndrome
(8) flap coverage required
|
Parameter
|
Finding
|
Points
|
|
percent cortical contact
|
100%
|
0
|
|
|
75%
|
1
|
|
|
50%
|
2
|
|
|
25%
|
3
|
|
ASA
|
ASA 1
|
1
|
|
|
ASA 2
|
2
|
|
|
ASA 3
|
3
|
|
sex
|
female
|
0
|
|
|
male
|
1
|
|
specific type
|
low-energy fracture
|
-1
|
|
|
spiral pattern
|
-1
|
|
|
other
|
0
|
|
closed vs open
|
closed
|
0
|
|
|
open
|
2
|
|
chronic disease
|
no
|
0
|
|
|
yes
|
3
|
|
compartment syndrome
|
no
|
0
|
|
|
yes
|
4
|
|
flap coverage required
|
no
|
0
|
|
|
yes
|
5
|
where:
• There is some uncertainty in scoring.
• Low-energy and spiral fracture could be separate, but minimum score is given as 0 indicating that only one is allowed.
• The percent cortical contact percent does not cover the entire range.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The higher the score the greater the risk of nonunioon.
|
Score
|
Percent Nonunion
|
|
0 to 5
|
2%
|
|
6 to 8
|
22%
|
|
9 to 11
|
42%
|
|
>= 12
|
61%
|
