Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions

Abstract

Background A majority of proximal humeral fractures can be managed without surgery. Recent randomized clinical trials and meta-analyses even question the benefit of surgical treatment for displaced 3-, and 4-part fractures. However, evidence-based treatment recommendations, balancing benefits and harms, presuppose a common reporting of complications and adverse events, which at the moment is largely missing. Therefore we systematically reviewed the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Methods We searched PubMed, EMBASE, Cochrane Library, Scopus and WorldCat (2010–2017) and included articles and book chapters containing complication terms or definitions. Two reviewers independently extracted and grouped terms and definitions according to a predefined scheme. Terms and definitions concerning non-surgical management were tabulated, grouped and analyzed qualitatively. Results The initial search identified 1376 references from which 470 articles were selected for full-text retrieval. Data-extraction included first articles published in 2017, was then performed iteratively in batches of 20 articles, and terminated after retrieval of 91 articles when no additional definitions or terms was found. In addition, 12 book chapters were reviewed from an initial list of 100. No general definition of a complication was found. A total of 69 terms for complications after non-surgical management were identified from 19 articles. Sixty-seven terms regarded local events. The most commonly reported event terms regarded osteonecrosis, malunion, secondary displacement and rotator cuff problems. Seven individual terms were accompanied by some kind of definition. Most terms and definitions were based on radiographical assessments. Conclusions We found no consensus in the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Multiple terms, some synonymous, some partly synonymous, some distinct, were used. Few complication terms were explicitly defined. Development and validation of an internationally consensus-based core event set for complications after proximal humeral fractures managed non-surgically is needed. Electronic supplementary material The online version of this article (10.1186/s12891-019-2459-6) contains supplementary material, which is available to authorized users.

Surgical or non-surgical treatment of traumatic skeletal fractures in adults: systematic review and meta-analysis of benefits and harms

“…The large inconsistency and often missing reporting of SAEs and death in the included trials represent a limitation of our study. The lack of consensus in terms and definitions of complications after treatment of fractures calls for the development and validation of a core set of complications [81]. Another potential limitation of this study relates to our selection of outcomes, as 39 trials were excluded due to insufficient data.…”

Left-Sided Humerus Fracture as an Unusual Complication of Defibrillation Threshold Testing Following S-ICD Implantation

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Complications after surgical management of proximal humeral fractures: a systematic review of event terms and definitions

“…Each full-text article or book chapter was reviewed by one of the authors; extracted data was double-checked by another author, and the senior author addressed any ambiguous terms. Event terms were classified according to the following treatment modalities of plate osteosynthesis, intramedullary nail fixation, arthroplasty, other surgical procedures and nonoperative management, the latter of which is already presented [14] and thus excluded from further analyses. References that were quoted in relation to a specific definition were also reviewed to assess the exactness of the citations.…”

“…To support the standardization of complication reporting in PHF treatment, we conducted a systematic literature review of event terms and definitions of complications after these fractures. While events associated with nonoperative management have been previously discussed [14], this report focuses on events reported in the context of surgical treatment options for PHFs.…”