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. 2025 Sep 18;16(9):110859.
doi: 10.5312/wjo.v16.i9.110859.

Deltopectoral vs deltoid split approach for proximal humerus fractures treated with locking plate: Our experience

Calogero Cicio  1 , Gianfranco Longo  2 , Vito Pavone  3 , Gianluca Testa  3 , Rocco Ortuso  2 , Giovanni C Salvo  2 , Marco Ganci  2 , Ignazio Prestianni  1 , Alessio Ferrara  1 , Antonio Kory  2 , Alessandro Pietropaolo  3 , Anna M Monachino  1 , Enrica R Cuffaro  1 , Giacomo Papotto  4
Affiliations

Deltopectoral vs deltoid split approach for proximal humerus fractures treated with locking plate: Our experience

Calogero Cicio et al. World J Orthop. .

Abstract

Background: Proximal humerus fractures (PHFs) are common, especially in the elderly, and optimal surgical management remains debated. This study compares clinical, functional, and radiographic outcomes of deltoid split (DS) vs deltopectoral (DP) approaches in PHFs treated with locking plates.

Aim: To evaluate and compare the clinical, functional, and radiographic outcomes-as well as postoperative complication rates-associated with the DS vs the DP surgical approach in the open reduction and internal fixation (ORIF) of PHFs using locking plate constructs.

Methods: A multicenter retrospective study of 120 patients undergoing ORIF for closed Neer type II-IV PHFs between January 2023 and December 2023. Patients were grouped by surgical approach [DS (n = 70), DP (n = 50)]. Outcome measures included Numeric Rating Scale (NRS) for pain, Quick-Disabilities in Arm, Shoulder, and Hand questionnaire (QuickDASH), Constant-Murley score, Short Form Health Survey-12v2, and radiographic alignment. Complication rates were recorded. Statistical significance was defined as P < 0.05.

Results: Early outcomes favored the DS group: (1) Lower NRS (3.1 vs 5.9); (2) Higher Constant-Murley (68.2 vs 50.5); and (3) Better QuickDASH (25.4 vs 37.1). Complication rate was lower in the DS group (1.66% vs 5.81%). Radiographic outcomes were comparable. Long-term results were similar between groups.

Conclusion: While both approaches yield satisfactory long-term outcomes, the DS approach is associated with faster early recovery and fewer complications, supporting its use in selected cases.

Keywords: Deltoid split; Deltopectoral; Functional outcome; Locking plate; Open reduction and internal fixation; Proximal humerus fracture.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Numeric Rating Scale pain score, Quick-Disabilities in Arm, Shoulder, and Hand questionnaire Score, and Constant-Murley score over time. A: Numeric Rating Scale Pain score; B: Quick-Disabilities in Arm, Shoulder, and Hand questionnaire score; C: Constant-Murley score. NRS: Numeric Rating Scale; QuickDASH: Quick-Disabilities in Arm, Shoulder, and Hand questionnaire.
Figure 2
Figure 2
Postoperative complications by group. AVN: Avascular necrosis.
See this image and copyright information in PMC

References

    1. Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011;93:1–11. - PubMed
    1. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987:160–164. - PubMed
    1. Beaton DE, Wright JG, Katz JN Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–1046. - PubMed
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804. - PubMed
    1. Wu Z, Shen W. An updated systematic review and metaanalysis comparing deltoidsplit approach with deltopectoral approach for proximal humerus fractures. Exp Ther Med. 2023;25:296. - PMC - PubMed

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