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Walker et al: Evaluation of a modified radiographic union scale for tibial fractures scoring system in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing
Veterinary Surgery 8, 2022

🔍 Key Findings

  • TPLO mRUST scoring showed improved inter-rater reliability (ICC = 0.56) compared to subjective evaluation (Kappa = 0.33).
  • Intra-rater reliability was similar for both methods (TPLO mRUST: 0.73, subjective: 0.72).
  • TPLO mRUST scores ≥10/12 strongly correlated with radiographic union, as subjectively assessed (99% agreement).
  • No significant difference in healing between first and second TPLO sides (P = .09), countering assumptions about load-bearing impact.
  • Higher initial lameness scores and younger age were associated with higher TPLO mRUST scores, suggesting more robust healing in those groups.
  • Postoperative complications were linked to lower TPLO mRUST scores, indicating impaired healing.
  • Medial cortex was excluded from scoring due to plate obstruction, validating use of only 3 cortices for scoring.
  • The TPLO mRUST system may standardize healing assessment, reducing subjective bias across specialties.

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← Articles

Walker et al: Evaluation of a modified radiographic union scale for tibial fractures scoring system in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing
Veterinary Surgery 8, 2022

🔍 Key Findings

  • TPLO mRUST scoring showed improved inter-rater reliability (ICC = 0.56) compared to subjective evaluation (Kappa = 0.33).
  • Intra-rater reliability was similar for both methods (TPLO mRUST: 0.73, subjective: 0.72).
  • TPLO mRUST scores ≥10/12 strongly correlated with radiographic union, as subjectively assessed (99% agreement).
  • No significant difference in healing between first and second TPLO sides (P = .09), countering assumptions about load-bearing impact.
  • Higher initial lameness scores and younger age were associated with higher TPLO mRUST scores, suggesting more robust healing in those groups.
  • Postoperative complications were linked to lower TPLO mRUST scores, indicating impaired healing.
  • Medial cortex was excluded from scoring due to plate obstruction, validating use of only 3 cortices for scoring.
  • The TPLO mRUST system may standardize healing assessment, reducing subjective bias across specialties.

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Multiple Choice Questions on this study

In Walker 2022 et al., on TPLO mRUST scoring, which minimum score was associated with a 99% likelihood of subjective union?

A. 6/12
B. 8/12
C. 9/12
D. 10/12
E. 12/12

Answer: 10/12

Explanation: Scores ≥10/12 were subjectively judged to represent radiographic union in 99% of cases.
In Walker 2022 et al., on TPLO mRUST scoring, which cortex was **excluded** from scoring due to plate obstruction?

A. Medial
B. Cranial
C. Lateral
D. Caudal
E. Proximal

Answer: Medial

Explanation: The medial cortex was obstructed by the TPLO plate and excluded from mRUST scoring.
In Walker 2022 et al., on TPLO mRUST scoring, which of the following was associated with **lower** mRUST scores?

A. Younger age
B. High lameness at presentation
C. No complications
D. Complications
E. Shorter radiographic interval

Answer: Complications

Explanation: Postoperative complications were associated with significantly lower TPLO mRUST scores (mean difference 1.4, P = .03).
In Walker 2022 et al., on TPLO mRUST scoring, which metric demonstrated the highest inter-rater reliability?

A. Subjective assessment of radiographic union
B. TPLO mRUST scoring system
C. Tibial plateau angle measurement
D. Owner-reported outcomes
E. Force plate analysis

Answer: TPLO mRUST scoring system

Explanation: The TPLO mRUST system had an inter-rater ICC of 0.56 vs 0.33 for subjective evaluation.
In Walker 2022 et al., on TPLO mRUST scoring, what effect did bilateral cruciate ligament injury have on healing between staged TPLOs?

A. Significantly faster healing in first side
B. Significantly slower healing in first side
C. No difference in healing between sides
D. Faster healing in second side only if complication-free
E. Slower healing only if plate type varied

Answer: No difference in healing between sides

Explanation: P = .09 showed no significant difference in healing between first and second TPLO surgeries.

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