Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
BMC Musculoskelet Disord. 2019 Feb 23;20(1):91. doi: 10.1186/s12891-019-2459-6.
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.
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.
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.
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.
大多数肱骨近端骨折可以不手术治疗。最近的随机临床试验和荟萃分析甚至对手术治疗移位的 3 部分和 4 部分骨折的益处提出了质疑。然而，基于证据的治疗建议，在权衡利弊时，假设并发症和不良事件的报告具有共同性，而目前这在很大程度上是缺失的。因此，我们系统地回顾了非手术治疗肱骨近端骨折后并发症术语和定义的使用情况。
我们在 PubMed、EMBASE、Cochrane 图书馆、Scopus 和 WorldCat（2010-2017 年）中进行了检索，并纳入了包含并发症术语或定义的文章和章节。两位评审员独立提取和分组术语和定义，根据预定义的方案进行。列出、分组和分析与非手术治疗相关的术语和定义，并进行定性分析。
最初的搜索确定了 1376 条参考文献，其中 470 篇文章被选为全文检索。数据提取从 2017 年发表的第一篇文章开始，然后分批进行，每次 20 篇文章，当没有发现其他定义或术语时，检索了 91 篇文章后终止。此外，还从最初的 100 篇列表中审查了 12 章书籍章节。没有发现一般的并发症定义。从 19 篇文章中确定了 69 个用于非手术治疗后并发症的术语。67 个术语与局部事件有关。最常报告的事件术语涉及骨坏死、愈合不良、二次移位和肩袖问题。7 个单独的术语附有某种定义。大多数术语和定义基于影像学评估。
我们发现非手术治疗肱骨近端骨折后并发症的术语和定义没有达成共识。使用了多个术语，有些是同义词，有些是部分同义词，有些是不同的，很少有并发症术语被明确定义。需要制定和验证一种基于国际共识的非手术治疗肱骨近端骨折后并发症的核心事件集。
