Outcomes of distal humerus fractures: What are we measuring?

INTRODUCTION: We evaluate the most common outcome measures used in distal humerus fracture studies in order to suggest standardization for future research.

MATERIALS AND METHODS: A systematic review identified articles assessing the outcomes of acute distal humerus fractures from 2006 to 2016 from PubMed and Web of Science databases. The inclusion criterion was studies reporting on the outcomes of treatment of acute distal humerus fractures. Review articles, meta-analyses, studies with<5 patients, technique articles, biomechanical studies, and those focusing on one complication/outcome were excluded. Patient demographics and all outcome measures were reviewed. Journal and demographic factors were then compared.

RESULTS: One-hundred-nine of 2158 articles met inclusion criteria. The median number of fractures per study was 35. Mean patient age was 55.0 years. Average follow-up was 35 months. Range-of-motion and strength measurements were reported in 90% and 17% of studies, respectively. Twenty patient-reported outcome instruments were used. The most commonly reported measures were MEPS, DASH, VAS pain, and Quick DASH scores. An average of 1.9 outcome measures were reported per study. A journal impact factor of≥1.5 was associated with more reported outcome measures. Articles including elbow arthroplasty were associated with higher impact factor journals, more outcome measures, and longer follow-up. Level of evidence was not associated with the number of reported outcome measures.

DISCUSSION: The current distal humerus fracture literature inconsistently reports outcome measures. More outcome measures were reported in higher impact journals. Future distal humerus fracture studies should include MEPS, DASH or Quick DASH, and VAS Pain scores to allow for appropriate cross-study comparison.

LEVEL OF EVIDENCE: IV, Systematic review.