title: A scoping review of the proximal humerus fracture literature.
abstract: BACKGROUND
  Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. The outcomes of these fractures are frequently disappointing and previous systematic reviews are unable to guide clinical practice. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of proximal humerus fractures.
  
  
  METHODS
  We utilized a scoping review technique because of its novel ability to map research activity and identify knowledge gaps in fields with diverse treatments. Through multiple electronic database searches, we identified a comprehensive body of proximal humerus fracture literature that was classified into eight research themes. Meta-data from each study were abstracted and descriptive statistics were used to summarize the results.
  
  
  RESULTS
  1,051 studies met our inclusion criteria with the majority of research being performed in Europe (64%). The included literature consists primarily of surgical treatment studies (67%) and biomechanical fracture models (10%). Nearly half of all clinical studies are uncontrolled case series of a single treatment (48%). Non-randomized comparative studies represented 12% of the literature and only 3% of the studies were randomized controlled trials. Finally, studies with a primary outcome examining the effectiveness of non-operative treatment or using a prognostic study design were also uncommon (4% and 6%, respectively).
  
  
  CONCLUSIONS
  The current study provides a comprehensive summary of the existing proximal humerus fracture literature using a thematic framework developed by a multi-disciplinary collaboration. Several knowledge gaps have been identified and have generated a roadmap for future research priorities.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Master University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. gslobogean@umoa.umm.edu.|Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, Canada. gslobogean@umoa.umm.edu.|Division of Orthopaedic Trauma, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland, 22 S. Greene Street, Baltimore, MD, USA. gslobogean@umoa.umm.edu.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland, 22 S. Greene Street, Baltimore, MD, USA. hermanjohal@gmail.com.
authors.forename: Herman
authors.initials: H
authors.lastname: Johal
authors.affiliation: Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, Canada. kelly.lefaivre@vch.ca.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Lefaivre
authors.affiliation: School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada. macint@mcmaster.ca.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: MacIntyre
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Master University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. sprags@mcmaster.ca.|Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. sprags@mcmaster.ca.
authors.forename: Sheila
authors.initials: S
authors.lastname: Sprague
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. scottta@mcmaster.ca.
authors.forename: Taryn
authors.initials: T
authors.lastname: Scott
authors.affiliation: Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, Canada. pierre.guy@ubc.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Guy
authors.affiliation: Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC, Canada. cripton@mech.ubc.ca.|Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, Canada. cripton@mech.ubc.ca.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cripton
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, Canada. mckeem@smh.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: McKee
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Master University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. bhandam@mcmaster.ca.|Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada. bhandam@mcmaster.ca.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015706:Bibliometrics; D001696:Biomechanical Phenomena; D035843:Biomedical Research; D017102:Fracture Healing; D016330:Frail Elderly; D006801:Humans; D006811:Humerus / Q000503:physiopathology / Q000601:surgery; D051188:Knowledge Bases; D008875:Middle Aged; D009985:Orthopedics; D012307:Risk Factors; D012784:Shoulder Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome