Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature.

ABSTRACT

Background: Displaced proximal humerus fractures generally result in long-term functional disability. Recently, the advances in treatment for proximal humerus fracture have involved minimally invasive plating which offer minimal soft tissue damage and rapid and improved healing of the fracture. In recent literature, there has been a shift towards the deltoid splitting approach for the fixation of proximal humeral fractures due to the increased visualization of the posterior fragments as well as the less amount of soft tissue stripping. We used the deltoid splitting approach to evaluate the feasibility and outcomes as regards to axillary nerve injury, complications and functional deficits. Methods: Out of a total of 35 patients included in this study, 28 were male and 7 were female; with a mean age of 44 (range26 - 62yrs.). Results: In patients, the fracture of the proximal humerus was classified as type III; while 30 % (n=6) had type II fracture, according to Neer’s classification. Depending upon the fracture anatomy and the need for exposure, the skin incision was a continuous long incision in 7cases, with complete exploration of axillary nerve in the substance of deltoid; while in 13 cases, fixation was done using two separate skin windows. The mean follow up period was 26weeks (range 18-32 weeks). The average time to radiological union was14 weeks (range12-2 0 weeks). At final follow up, there were no cases of nonunion. There were 2 cases (10%) with varus malunion of the head fragment, and 1 case (5%) of acromial impingement. Axillary nerve palsy or deltoid dysfunction was not seen in any of the patients. The mean Constant- Murley score of shoulder function, at final follow up, was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, by calculating the difference of score between the involved shoulder and the uninvolved shoulder, 60% patients(n=12) had excellent, 35% (n=7) had good and 5% (n=1) had fair functional results. Conclusion: Thus deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits.