Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Three part and four-part fractures of the proximal humerus offer challenges in reduction and plate fixation, with considerable debate about use of Deltoid splitting (DS) and Delto-pectoral (DP) approaches, especially when they involving the greater tuberosity. We prospectively compared the results using DS approach and DP approach in these cases, with special focus on functional outcomes, complications, and ease of tuberosity reduction.

Materials and methods

84 patients with three- and four-part proximal humerus fracture were alternately allocated the DP approach or DS approach for proximal humerus locking plate fixation. The outcome analysis was done by evaluating relative Constant score and ease of surgical reduction of greater tuberosity; radiological malunion was evaluated using Beredjiklian classification and complications were noted.

Results

At mean follow-up of 23 months (19–48 months), the mean ‘relative Constant score was 74.27 ± 8.19 in the DP group and 73.26 ± 8.02 in the DS group and the difference was statistically insignificant (p = 0.988). There was no significant difference with respect to shoulder ROM, abductor strength, radiological malunion or complications. However, the mean surgical time was significantly less (p value = 0.042) in DS group (65 ± 5 min) in comparison to DP group (92 ± 4.3 min); significantly less difficulties were documented by the surgeon in reducing the greater tuberosity in DS group(p value = 0.02).

Conclusion

Although surgical time was reduced and greater tuberosity reduction was easier in DS group, the other outcomes were similar; either surgical approach can be used based, and can be based on the experience and comfort level of the surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Data available in excel form without any details of patient’s identity.

References

  1. Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 2012;98:715–9.

    Article  CAS  PubMed  Google Scholar 

  2. Robinson CM, Amin AK, Godley KC, Murray IR, White TO. Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma. 2011;25:618–29.

    Article  PubMed  Google Scholar 

  3. Demirhan M, Kilicoglu O, Altinel L, et al. Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma. 2003;17:181–8.

    Article  PubMed  Google Scholar 

  4. Aksu N, Aslan O, Kara AN, et al. Simultaneous repair of chronic full-thickness rotator cuff tears during fixation of proximal humerus fractures and clinical results. Acta OrthopTraumatol Turc. 2010;44:173–9.

    Article  Google Scholar 

  5. Hepp P, Theopold J, Voigt C, Engel T, Josten C, Lill H. The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elbow Surg. 2008;17:21–8.

    Article  PubMed  Google Scholar 

  6. Roderer G, Erhardt J, Kuster M, Vegt P, Bahrs C, Kinzl L, Gebhard F. Second generation locked plating of proximal humerus fractures—a prospective multicentre observational study. Int Orthop. 2011;35:425–32.

    Article  PubMed  Google Scholar 

  7. Wu CH, Ma CH, Yeh JJH, Yen CY. Locked plating for proximal humeral fractures: differences between the deltopectoral and deltoid-splitting approaches. J Trauma. 2011;71:1364–70.

    PubMed  Google Scholar 

  8. Berkes MB, Little MT, Lorich DG. Open reduction internal fixation of proximal humerus fractures. Curr Rev Musculoskelet Med. 2013;6:47–56.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res. 2014;472:1576–85.

    Article  PubMed  Google Scholar 

  10. Neer CS II. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Jt Surg Am. 1970;52:1077–89.

    Article  Google Scholar 

  11. Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat research. 2013;471:39–43.

    Article  Google Scholar 

  12. Beredjiklian PK, Iannotti JP, Norris TR, Williams GR. Operative treatment of malunion of a fracture of the proximal aspect of the humerus. J Bone Jt Surg Am. 1998;80:1484–97.

    Article  CAS  Google Scholar 

  13. Constant CR, Gerber C, Emery RJH. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17:355–61.

    Article  PubMed  Google Scholar 

  14. Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23:163–72.

    Article  PubMed  Google Scholar 

  15. Gallo RA, Zeiders GJ, Altman GT. Two-incision technique for treatment of complex proximal humerus fractures. J Orthop Trauma. 2005;19:734–40.

    Article  PubMed  Google Scholar 

  16. Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head: an anatomical study. J Bone Jt Surg Am. 1990;72:1486–94.

    Article  CAS  Google Scholar 

  17. Robinson CM, Khan L, Akhtar A, Whittaker R. The extended deltoid-splitting approach to the proximal humerus. J Orthop Trauma. 2007;21:657–62.

    Article  PubMed  Google Scholar 

  18. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal humerus. J Orthop Trauma. 2008;22:132–7.

    Article  PubMed  Google Scholar 

  19. Liu K, Liu PC, Liu R, Wu X. Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures. Med Sci Monit. 2015;21:496–504.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Iyengar JJ, Ho J, Feeley BT. Evaluation and management of proximal humerus fractures. Phys Sportsmed. 2011;39:52–61.

    Article  PubMed  Google Scholar 

  21. Xie L, Zhang Y, Chen C, Zheng W, Chen H, Cai L. Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2019;105:307–16.

    Article  PubMed  Google Scholar 

  22. Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AA. Surgical management of complex proximal humerus fractures—a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;29:54–9.

    Article  PubMed  Google Scholar 

Download references

Funding

None of the author have received any funding for the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Himanshu Bhayana, Devendra Kumar Chouhan, Sameer Aggarwal, Sandeep Patel, Chirag Arora & Mandeep Singh Dhillon

  2. Department of Radiodiagnosis, PGIMER, Chandigarh, India

    Mahesh Prakash

Authors
  1. Himanshu Bhayana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devendra Kumar Chouhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sameer Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahesh Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandeep Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chirag Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mandeep Singh Dhillon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devendra Kumar Chouhan.

Ethics declarations

Conflict of interest

None of the author have any conflict of interest to disclose.

Ethical approval

Approval obtained from department review board.

Consent to participate

Informed written consent obtained from all the participants.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhayana, H., Chouhan, D.K., Aggarwal, S. et al. Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach. Eur J Trauma Emerg Surg 48, 4559–4567 (2022). https://doi.org/10.1007/s00068-021-01761-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-021-01761-6

Keywords

Search

Navigation