Comparison of deltoid-splitting approach versus deltopectoral approach for the management of proximal humeral fractures with Philos plate

Abstract

Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Three and four-part fractures (13-16% of proximal humerus fractures) have been a challenge to achieve stable fixation. Difficulties have been multifactorial, including osteoporotic bone, angular instability, implant impingement, loss of reduction and backing out of screws. A total of 22 patients with proximal humeral fractures were divided in two groups, in Group A, patient’s classical deltopectoral approach utilized, while in Group B deltoid-splitting approach was used. All patients were managed by PHILOS plate fixation. Cases were followed up clinically as well as radiologically at 2 weeks , 6 weeks, 12 weeks, 3 months , 6 months and one year. Functional outcomes of patient were accessed in terms Constant Scoring System, while radiological evaluation was done by taking x-rays to access quality of reduction and union of fracture. All patients were followed for a minimum of 18 months. In Group B, reduction of greater tuberosities was better in 3 part and 4 part fractures. Mean Constant score in Group A at the end of 3 months was 46, while in Group B it was 62 and statistically significant (P = 0.02). At the end of 18 months, mean Constant score in Group A was 67, while in Group B it was 68 and statistically insignificant (P = 0.72). Complications like One fracture (open)in group A was associated with deep infection, loss of reduction of fracture in one patient in group B & primary screw perforation in one patien in group B. There were no nonunions, osteonecrosis and implant breakage. We recommend deltopectoral aproach for calcar reconstruction in 3 & 4 parts fracture and deltoid splitting for greater tuberosity reduction in 2, 3 & 4 parts fracture.