Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

BACKGROUND: Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method.
METHODS: Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores.
RESULTS: It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p0.05).
DISCUSSION: Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid
splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.

Proksimal humerus kýrýklarýnýn tedavisinde lateral deltoid split giriþim ile deltopektoral giriþimin karþýlaþtýrýlmasý

AMAÇ: Proksimal humerus kýrýklarý sýk görülen ve fonksiyonel kýsýtlanmaya neden olan kýrýklardandýr. Bu geriye dönük çalýþmanýn amacý ayný fiksasyon metodu kullanýlarak deltopektoral ile deltoid split giriþimin karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Eylül 2005 ile Temmuz 2011 arasýnda bu iki giriþim kullanýlarak cerrahi tedavi edilen 86 hasta çalýþmaya alýndý. Grup A deltoid split giriþim, Grup B deltopektoral giriþim kullanýlan hastalardan oluþturuldu. Grup A 22 erkek, 34 kadýn toplam 56 hastanýn yaþ ortalamasý 62.5 yýl (26-90 yýl), Grup B 14 erkek, 16 kadýn, toplam 30 hastanýn yaþ ortalamasý 54.8 yýl (24-84 yýl) idi. Tüm hastalarda internal fiksasyon aracý olarak PHÝLOS plak vida sistemi kullanýldý. Her iki grubun fonksiyonel sonuçlarý ve komplikasyonlarý karþýlaþtýrýldý.
BULGULAR: Lateral deltoid split giriþim kullanýlan olgularda baþ ve tüberküler fragman redüksiyonunun daha iyi olduðu ve Constant omuz skorunun erken dönemde daha yüksek olduðu saptandý (sýrasýyla, 66.8-57.4; p<0.01). Aksiller sinir gözlenip askýya alýndýðý için bu sinire ait komplikasyon saptanmadý. Altýncý aydaki Constant skorlarý arasýnda anlamlý farklýlýk saptanmadý (sýrasýyla, 92.2-91.3; p>0.05).
SONUÇ: Deltoid split giriþim, özellikle AO/ASÝF B ve C tipi kýrýklarda proksimal humerusun 270 derece kontrolüne, tüberküler parçalardan ve döndürücü manþet tendonlarýndan geçirilen dikiþlerle redüksiyon ve plaða tespitine olanak saðlamaktadýr. Deltopektoral giriþime göre hastanýn iyileþme sürecinde Constant skorlarý anlamlý olarak farklýdýr. Aksiller siniri eksplore ederek yapýlan lateral deltoid split giriþim, deltoid kas fonksiyonlarýný ve aksiller siniri tehlikeye atmadan geniþ ve çok yönlü kýrýk kontrolü saðlayan faydalý bir cerrahi giriþim tekniðidir.