George J Richard1, Patrick J Denard2, Scott G Kaar3, Kamal I Bohsali4, J Gabriel Horneff5, Shannon Carpenter6, Catherine J Fedorka7, Kelly Mamelson8, Grant E Garrigues9, Surena Namdari5, Joseph A Abboud5, E Scott Paxton10, David Kovacevic11, Jonah Hebert-Davies12, Brent A Ponce13, Joseph J King14. 1. Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA. 2. Southern Oregon Orthopedics, Medford, OR, USA. 3. Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA. 4. Jacksonville Orthopaedic Institute-Beaches Division, Jacksonville, FL, USA. 5. Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. 6. Department of Orthopaedic Surgery, Dwight D. Eisenhower VAMC, Leavenworth, KS, USA. 7. Cooper Bone and Joint Institute, Cooper Medical School at Rowan University, Camden, NJ, USA. 8. Florida State University College of Medicine, Tallahassee, FL, USA. 9. Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. 10. Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, RI, USA. 11. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA. 12. Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA. 13. Department of Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. 14. Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA. Electronic address: kingjj@ortho.ufl.edu.
Abstract
BACKGROUND: The American Shoulder and Elbow Surgeons multicenter taskforce studying proximal humerus fractures reached no consensus on which outcome measures to include in future studies, and currently no gold standard exists. Knowledge of commonly used outcome measures will allow standardization, enabling more consistent proximal humerus fracture treatment comparison. This study identifies the most commonly reported outcome measures for proximal humerus fracture management in recent literature. METHODS: A systematic review identified all English-language articles assessing proximal humerus fractures from 2008 to 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Review articles, meta-analyses, revision surgery, chronic injuries, studies with <15 patients, studies with <12 month follow-up, anatomic/biomechanical studies, and technique articles were excluded. Included studies were assessed for patient demographics and outcome scores, patient satisfaction, complications, range of motion, and strength. RESULTS: Of 655 articles, 74 met inclusion criteria. The number of proximal humerus fractures averaged 74.2 per study (mean patient age, 65.6 years). Mean follow-up was 30.7 months. Neer type 1, 2, 3, and 4 fractures were included in 8%, 51%, 81%, and 88% of studies, respectively. Twenty-two patient-reported outcome instruments were used including the Constant-Murley score (65%), Disabilities of the Arm, Shoulder, and Hand score (31%), visual analog scale pain (27%), and American Shoulder and Elbow Surgeons score (18%). An average of 2.2 measures per study were reported. CONCLUSION: Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging. We recommend that future literature on proximal humerus fractures use at least 3 outcomes measures and 1 general health score until the optimal scores are determined. Published by Elsevier Inc.
BACKGROUND: The American Shoulder and Elbow Surgeons multicenter taskforce studying proximal humerus fractures reached no consensus on which outcome measures to include in future studies, and currently no gold standard exists. Knowledge of commonly used outcome measures will allow standardization, enabling more consistent proximal humerus fracture treatment comparison. This study identifies the most commonly reported outcome measures for proximal humerus fracture management in recent literature. METHODS: A systematic review identified all English-language articles assessing proximal humerus fractures from 2008 to 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Review articles, meta-analyses, revision surgery, chronic injuries, studies with <15 patients, studies with <12 month follow-up, anatomic/biomechanical studies, and technique articles were excluded. Included studies were assessed for patient demographics and outcome scores, patient satisfaction, complications, range of motion, and strength. RESULTS: Of 655 articles, 74 met inclusion criteria. The number of proximal humerus fractures averaged 74.2 per study (mean patient age, 65.6 years). Mean follow-up was 30.7 months. Neer type 1, 2, 3, and 4 fractures were included in 8%, 51%, 81%, and 88% of studies, respectively. Twenty-two patient-reported outcome instruments were used including the Constant-Murley score (65%), Disabilities of the Arm, Shoulder, and Hand score (31%), visual analog scale pain (27%), and American Shoulder and Elbow Surgeons score (18%). An average of 2.2 measures per study were reported. CONCLUSION: Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging. We recommend that future literature on proximal humerus fractures use at least 3 outcomes measures and 1 general health score until the optimal scores are determined. Published by Elsevier Inc.