Does the non-union scoring system (NUSS) affect the treatment approach of non-union?

Abstract

Aim: To investigate the effectiveness of the non-union scoring system (NUSS) in predicting the result and in guiding the treatment by comparing the treatment methods applied to non-union patients we treat in our clinic with the treatment methods suggested by the NUSS.

Methods: The study included 116 patients, who were diagnosed with long bone (femur, tibia and humerus) non-union and treated in our clinic. Of the 116 patients with non-union, 48 had femur (41.38 %), 39 had tibia (33.62%) and 29 had humerus (25%) non-union. The patient scores were calculated according to the NUSS criteria. The patients were divided into four groups according to their total scores. There were 34 patients in the first group (0-25 points), 49 patients in the second group (26-50 points), 30 patients in the third group (51-75 points) and three patients in the fourth group (76-100 points).

Results: Union that was achieved in 79 (68.10%) of all patients was detected in 97.05% of the patients in the first group, 83.67% in the second group, and 16.66 % in the third group. Amputation, arthroplasty and arthrodesis were applied to three patients in the fourth group. While union rate was 100 % in the femur and tibia in the first group, it was 90% in the humerus. The union rates were 85.71% in the humerus, 75% in the femur and 100% in the tibia in the second group. They were 20 % in the humerus, 15.38% in the femur and 16.66% in the tibia in the third group. The number of patients treated with the treatment proposed by the NUSS: 100% in the group 1, 83.67% in the group 2, 20% in the group 3 and 100% in the group 4. The risk of non-union in those who were not treated according to the NUSS recommendations was 28 times higher than that of others.

Conclusions: The results of our study suggest that more frequent use of the NUSS procedure in non-union treatment planning may increase treatment success. In addition, NUSS can provide information about the treatment process of non-unions.