Dataset Information

Core set of unfavorable events of proximal humerus fracture treatment defined by an international Delphi consensus process.

ABSTRACT:

Background

Proximal humerus fracture (PHF) complications, whether following surgery or nonoperative management, require standardization of definitions and documentation for consistent reporting. We aimed to define an international consensus core event set (CES) of clinically-relevant unfavorable events of PHF to be documented in clinical routine practice and research.

Methods

A Delphi exercise was implemented with an international panel of experienced shoulder trauma surgeons selected by survey invitation of AO Trauma members. An organized list of PHF events after nonoperative or operative management was developed and reviewed by panel members using on-line surveys. The proposed core set was revised regarding event groups along with definitions, specifications and timing of occurrence. Consensus was reached with at least a two-third agreement.

Results

The PHF consensus panel was composed of 231 clinicians worldwide who responded to at least one of two completed surveys. There was 93% final agreement about three intraoperative local event groups (device, osteochondral, soft tissue). Postoperative or nonoperative event terms and definitions organized into eight groups (device, osteochondral, shoulder instability, fracture-related infection, peripheral neurological, vascular, superficial soft tissue, deep soft tissue) were approved with 96 to 98% agreement. The time period for documentation ranged from 30 days to 24 months after PHF treatment depending on the event group and specification. The resulting consensus was presented on a paper-based PHF CES documentation form.

Conclusions

International consensus was achieved on a core set of local unfavorable events of PHF to foster standardization of complication reporting in clinical research and register documentation.

Trial registration

Not applicable.

SUBMITTER: Audige L

PROVIDER: S-EPMC8630858 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:INTRODUCTION:In locked plate fixation of proximal humerus fractures, the calcar is an important anchor point for screws providing much-needed medial column support. Most locking plate implants utilize a fixed-trajectory locking screw to achieve this goal. Consequently, adjustments of plate location to account for patient-specific anatomy may result in a screw position outside of the calcar. To date, little is known about the consequences of "missing" the calcar during plate positioning. This study sought to characterize the biomechanics associated with proximal and distal placement of locking plates in a two-part fracture model. MATERIALS AND METHODS:This experiment was performed twice, first with elderly cadaveric specimens and again with osteoporotic sawbones. Two-part fractures were simulated and specimens were divided to represent proximal, neutral, and distal plate placements. Non-destructive torsional and axial compression tests were performed prior to an axial fatigue test and a ramp to failure. Torsional stiffness, axial stiffness, humeral head displacement and stiffness during fatigue testing, and ultimate load were compared between groups. RESULTS:Cadavers: Proximal implant placement led to trends of decreased mechanical properties, but there were no significant differences found between groups. Sawbones: Distal placement increased torsional stiffness in both directions (p?=?0.003, p?=?0.034) and axial stiffness (p?=?0.018) when compared to proximal placement. Distal placement also increased torsional stiffness in external rotation (p?=?0.020), increased axial stiffness (p?=?0.024), decreased humeral head displacement during fatigue testing, and increased stiffness during fatigue testing when compared to neutral placement. DISCUSSION:The distal and neutral groups had similar mechanical properties in many cadaveric comparisons while the proximal group trended towards decreased construct stiffness. RESULTS:from the Sawbones model were more definitive and provided further evidence that proximal calcar screw placements are undesirable and distal implant placement may provide improved construct stability. CONCLUSION:Successful proximal humerus fracture reconstruction is inherent upon anatomic fracture reduction coupled with medial column support. Results from this experiment suggest that missing the calcar proximally is deleterious to fixation strength, while it is safe, and perhaps even desirable, to aim slightly distal to the intended target.

Project description:ObjectivesTo develop a consensus statement to provide advice on designing, implementing and evaluating crowdsourcing challenge contests in public health and medical contexts.DesignModified Delphi using three rounds of survey questionnaires and one consensus workshop.SettingUganda for face-to-face consensus activities, global for online survey questionnaires.ParticipantsA multidisciplinary expert panel was convened at a consensus-development conference in Uganda and included 21 researchers with experience leading challenge contests, five public health sector workers, and nine Ugandan end users. An online survey was sent to 140 corresponding authors of previously published articles that had used crowdsourcing methods.ResultsA subgroup of expert panel members developed the initial statement and survey. We received responses from 120 (85.7%) survey participants, which were presented at an in-person workshop of all 21 panel members. Panelists discussed each of the sections, revised the statement, and participated in a second round of the survey questionnaire. Based on this second survey round, we held detailed discussions of each subsection with workshop participants and further revised the consensus statement. We then conducted the third round of the questionnaire among the 21 expert panelists and used the results to finalize the statement. This iterative process resulted in 23 final statement items, all with greater than 80% consensus. Statement items are organised into the seven stages of a challenge contest, including the following: considering the appropriateness, organising a community steering committee, promoting the contest, assessing contributions, recognising contributors, sharing ideas and evaluating the contest (COPARSE).ConclusionsThere is high agreement among crowdsourcing experts and stakeholders on the design and implementation of crowdsourcing challenge contests. The COPARSE consensus statement can be used to organise crowdsourcing challenge contests, improve the rigour and reproducibility of crowdsourcing research and enable large-scale collaboration.