Outcome Measures Reported for the Management of Proximal Humeral Fractures: A Systematic Review

Abstract Background The ASES 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 PRISMA guidelines. Review articles, meta-analyses, revision surgery, chronic injuries, studies with Results Seventy-four of 655 articles 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%), DASH score (31%), VAS Pain (27%), and ASES 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 three outcomes measures and one general health score until the optimal scores are determined. Level of Evidence Level IV; Systematic Review