Slobogean Gerard P, Johal Herman, Lefaivre Kelly A, MacIntyre Norma J, Sprague Sheila, Scott Taryn, Guy Pierre, Cripton Peter A, McKee Michael, Bhandari Mohit
Division of Orthopaedic Surgery, Department of Surgery, Master University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada.
Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, Canada.
BMC Musculoskelet Disord. 2015 May 10;16:112. doi: 10.1186/s12891-015-0564-8.
Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. The outcomes of these fractures are frequently disappointing and previous systematic reviews are unable to guide clinical practice. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of proximal humerus fractures.
We utilized a scoping review technique because of its novel ability to map research activity and identify knowledge gaps in fields with diverse treatments. Through multiple electronic database searches, we identified a comprehensive body of proximal humerus fracture literature that was classified into eight research themes. Meta-data from each study were abstracted and descriptive statistics were used to summarize the results.
1,051 studies met our inclusion criteria with the majority of research being performed in Europe (64%). The included literature consists primarily of surgical treatment studies (67%) and biomechanical fracture models (10%). Nearly half of all clinical studies are uncontrolled case series of a single treatment (48%). Non-randomized comparative studies represented 12% of the literature and only 3% of the studies were randomized controlled trials. Finally, studies with a primary outcome examining the effectiveness of non-operative treatment or using a prognostic study design were also uncommon (4% and 6%, respectively).
The current study provides a comprehensive summary of the existing proximal humerus fracture literature using a thematic framework developed by a multi-disciplinary collaboration. Several knowledge gaps have been identified and have generated a roadmap for future research priorities.
肱骨近端骨折是一种常见的脆性骨折，会严重影响老年人的独立性。这些骨折的治疗结果常常令人失望，以往的系统评价无法指导临床实践。通过知识使用者的综合协作，我们试图梳理现有文献的广度，以指导肱骨近端骨折的治疗。
我们采用了范围综述技术，因为它具有独特的能力来梳理研究活动，并识别不同治疗领域的知识空白。通过多个电子数据库检索，我们确定了大量关于肱骨近端骨折的文献，并将其分为八个研究主题。提取每项研究的元数据，并使用描述性统计来总结结果。
1051项研究符合我们的纳入标准，其中大部分研究在欧洲进行（64%）。纳入的文献主要包括手术治疗研究（67%）和生物力学骨折模型（10%）。几乎所有临床研究的一半是单一治疗的非对照病例系列（48%）。非随机对照研究占文献的12%，只有3%的研究是随机对照试验。最后，以非手术治疗效果为主要结局或采用预后研究设计的研究也很少见（分别为4%和6%）。
本研究使用多学科合作开发的主题框架，对现有的肱骨近端骨折文献进行了全面总结。已识别出几个知识空白，并为未来的研究重点制定了路线图。
