The radiographic union scale in tibial fractures (RUST) was recently developed to assess the healing of tibial shaft fractures after intramedullary nailing, and it uses a numerical value for each tibial cortex. It was based on bridging callus and fracture line visibility, which were found to be the most reliable signs of bone healing between observers. The validity and reliability of the RUST score have been previously evaluated. Yet, this radiographic scoring system does not propose an exact score to define bone union. A weakness of the RUST score is that the evaluation becomes dichotomous (i.e., the fracture line is visible or not) after bridging callus has occurred.
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