University College London Hospital, London, United Kingdom.
Centre for Evidence-Based Orthopaedics, Department of Orthopedic Surgery, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Injury. 2022 Oct;53(10):3326-3331. doi: 10.1016/j.injury.2022.07.026. Epub 2022 Jul 17.
Proximal humerus fractures (PHF) should be subject to standardized monitoring during treatment, whether non-operative or operative, to document and adequately assess bone healing. The purpose of this study was to develop a standardized protocol for an image-based monitoring of PHF for joint-preserving treatment options, including a minimum set of descriptors or definitions of features of radiographic images, to be applied in clinical routine practice and studies.
A Delphi exercise was implemented with an international panel of experienced shoulder trauma surgeons self-selected after invitation of all AO Trauma members. Using open questions participants recommended the type and timing of desired diagnostic images, and formulated definitions for the imaging parameters they considered most important. Formulated recommendations for the type and timing of radiological fracture monitoring and clarification of the definitions of the proposed radiological parameter set were subjected to further survey. Consensus for each factor was considered to have been reached when there was at least a two-thirds agreement in the survey participants.
Response rates of 231 interested surgeons were 66% and 44% for the first and second survey respectively. Sixty percent of participants to the first survey responded to the second (131/219). 93% of respondents considered radiographic monitoring to be an important part of fracture care. 92% of respondents to the first survey considered that 'malreduction' should be assessed, and 165 of 189 respondents provided a suggestion for a definition for this parameter. 88% of respondents to the second survey agreed on a redefinition of the term 'malreduction' as 'non-anatomical fracture reduction'. There was substantial agreement about the radiographic views and orientation of radiographs to be recorded (80%) and the timing of radiological reviews (67- 78% for time points during follow up). Just over half of respondents recommended cessation of radiological review when fracture healing was considered to have occurred by radiological evaluation.
Our work confirmed the need for clear definitions of radiological features that should be considered in the follow-up of proximal humeral fractures. It has resulted in the development of an international consensus monitoring protocol for PHF treatment with a structured core set of radiological parameters. Clinical application and validation of the monitoring process are needed.
无论是非手术治疗还是手术治疗，肱骨近端骨折（PHF）都应在治疗过程中进行标准化监测，以记录和充分评估骨愈合情况。本研究的目的是为保留关节的治疗选择制定一种基于影像学的 PHF 监测标准化方案，包括一套最小的描述符或定义放射图像特征，以便在临床常规实践和研究中应用。
采用德尔菲法（Delphi），邀请所有 AO 创伤协会成员后，自行选择国际经验丰富的肩创伤外科医生组成专家小组。使用开放性问题，参与者推荐所需的诊断图像类型和时间，并为他们认为最重要的影像学参数制定定义。对放射学骨折监测的类型和时间以及对所提出的放射学参数集的定义进行进一步调查。当调查参与者中有至少三分之二的人达成一致时，就认为每个因素的共识已经达成。
对第一次和第二次调查感兴趣的 231 名外科医生的回复率分别为 66%和 44%。第一次调查中 60%的参与者回复了第二次调查（131/219）。93%的受访者认为放射学监测是骨折治疗的重要组成部分。92%的第一次调查受访者认为应评估“复位不良”，189 名受访者中有 165 名提供了该参数的定义建议。第二次调查中有 88%的受访者同意将“复位不良”重新定义为“非解剖复位”。对于要记录的放射学视图和放射学照片的方向（80%）以及放射学复查的时间（随访期间的 67-78%时间点），受访者之间存在很大的一致性。超过一半的受访者建议在通过放射学评估认为骨折愈合时停止放射学复查。
我们的工作证实了需要明确定义应在肱骨近端骨折随访中考虑的放射学特征。它促成了一种用于 PHF 治疗的国际共识监测方案的制定，该方案具有结构化的核心放射学参数集。需要对监测过程进行临床应用和验证。
