Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Abstract

Background Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Questions/purposes In this prospective randomized study, we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to (1) complication rate; (2) shoulder function (Constant score); and (3) pain (visual analog scale [VAS]) for internal fixation of displaced humeral fractures with a polyaxial locking plate.Methods We randomized 120 patients with proximal humeral fractures to receive one of these two approaches (60 patients for each approach). We prospectively documented demographic and perioperative data (sex, age, fracture type, hospital stay, operation time, and fluoroscopy time) as well as complications. Followup examinations were conducted at 6 weeks, 6 months, and 12 months postoperatively, including radiological and clinical evaluations (Constant score, activities of daily living, and pain [VAS]). Baseline and perioperative data were comparable for both approaches. The sample size was chosen to provide 80% power, but it reached only 68% as a result of the loss of followups to detect a 10-point difference on the Constant score, which we considered the minimum clinically important difference. Results Complications or reoperations between the approaches were not different. Eight patients in the deltoid-split group (14%) needed surgical revisions compared with seven patients in the deltopectoral group (13%; p = 1.00). Deltoid-split and deltopectoral approaches showed similar Constant scores 12 months postoperatively (Deltoid-split 81; 95% confidence interval [CI], 74-87 versus deltopectoral 73; 95% CI, 64-81; p = 0.13), and there were no differences between the groups in terms of pain at 1 year (deltoid-split 1.8; 95% CI, 1.2-1.4 versus deltopectoral 2.5; 95% CI, 1.7-3.2; p = 0.14). No learning-curve effects were noted; fluoroscopy use during surgery and function and pain scores during followups were similar among the first 30 patients and the next 30 patients treated in each group. Conclusions The treatment of proximal humeral fractures with a polyaxial locking plate is reliable using both approaches. For a definitive recommendation for one of these approaches, further studies with appropriate sample size are necessary.

Functional outcome of displaced proximal humerus fractures managed by proximal humerus interlocking system plate

“…7 Comparing with this study, the present study of 20 patients were all discharged on 10th postoperative day except for 1 patient who had postoperative superficial infection, following which culture and sensitivity was done and as per the reports, culture-specific IV antibiotics was continued until infection subsided and suture removal was delayed till 17th postoperative day and was discharged. The present study results are comparable to the other study.…”

Techniques for Using a Novel Intramedullary Cage Technology for Fixation of Proximal Humeral Fractures

“…Locking plates are indicated for 2-, 3-and 4-part fractures with a few exceptions where a prosthetic replacement may be needed. A deltopectoral surgical incision is most commonly used for such ORIF procedures as it provides direct visualization of the fracture fragments [14]. Buttressing the medial calcar is critical to fracture stability following fixation [25].…”

“…A deltopectoral approach is the most commonly used surgical incision for the reduction and fixation of proximal humerus fractures [14]. The patient can be positioned in a beach-chair position or a supine position depending on surgeon preference.…”

Clinical outcomes and prognostic factors depending on implant design in the treatment of proximal humeral fractures: A retrospective study

“…9 After performing reduction using the joy-stick method, we inserted an intramedullary nail through the optimal position in accordance with each manufacturer's implant instructions. Nails in the S group were inserted through the central tip of the humeral head, while nails in the C group were inserted through the central or slightly lateral position of the humeral head.…”