Developing a core outcome set for acetabular fractures: a systematic review (part I)

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Clinical Research Methodology

Background:

• Surgical treatment studies for acetabular fractures exhibit outcome heterogeneity, hindering research comparability and knowledge synthesis.
• A standardized core outcome set (COS) for surgically treated acetabular fractures is currently lacking.
• This study aimed to identify and categorize outcomes reported in existing literature on surgically treated acetabular fractures.

Purpose of the Study:

• To systematically identify and catalog all outcomes reported in clinical studies investigating the surgical treatment of acetabular fractures.
• To provide a foundation for the development of a core outcome set (COS) for acetabular fracture surgery.
• To address the heterogeneity in outcome measurement in acetabular fracture research.

Main Methods:

• Systematic literature search of three databases and two clinical trial registries (updated November 15, 2022).
• Inclusion criteria: skeletally mature individuals (≥16 years) with isolated acetabular fractures treated surgically.
• Exclusion criteria: polytrauma, pathological fractures, additional pelvic fractures, non-surgical treatment, or juvenile individuals. Outcomes were grouped and categorized using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.

Main Results:

• 193 studies yielded 2581 outcomes, resulting in 266 unique outcomes after grouping.
• No single outcome was reported in all studies; the most frequent were pain, independent ambulation, range of motion, reduction quality, and heterotopic ossification (in ≥60% of studies).
• Significant variation existed in outcome naming, definition, measurement timing, and instruments used, with 105 outcomes reported in only one study.

Conclusions:

• A wide array of outcomes are inconsistently measured in studies of surgically treated acetabular fractures.
• The identified outcomes span all five core areas and 25 domains of the COMET taxonomy.
• These findings will inform the subsequent development of a COS for acetabular fracture surgery using the Delphi method.