The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome

Abstract

This study evaluated the influence of the surgical approach for locking plate osteosynthesis in proximal humeral fractures during a 1-year period. We performed a comparative study in 83 patients to evaluate possible benefits for an early functional result for function, pain, activity levels, radiographic evaluation, and complications. In 39 cases, the extended anterolateral deltoid-splitting approach was used (group DS); in 44 cases, the deltopectoral approach was used (group DP). The clinical and radiologic follow-up took place 3, 6, and 12 months after the operation. The functional results in the adjusted Constant score after 3 months showed higher values for group DS of 57.9% vs group DP with 49.6%. After 6 months, no significant differences were seen, with 69.4% for group DS and 71.4% for group DP. Finally, after 12 months, group DP showed higher results at 81% compared with 73.1% for DS. In the subgroups of the Constant score, abduction and active anterior elevation showed particularly higher values in group DP. The duration of the operation was 67 minutes in group DS and 86 minutes in group DP. One case of avascular necrosis was observed in group DS and 3 in group DP. We conclude that the choice of approach for exposure of the proximal humerus region may influence the functional outcome. Stable osteosynthesis is important, but the outcome of operatively treated proximal humerus fractures is dependent on soft tissue management as well.