title: Locked plating for proximal humeral fractures: differences between the deltopectoral and deltoid-splitting approaches.
abstract: BACKGROUND
  Locking proximal humerus plate (LPHP) fixation has recently become available for the treatment of proximal humeral fractures. However, the preliminary results were contradictory. The technical requirements for success when using LPHP remain to be defined. Maybe the approach to the proximal humerus plays an important role, not the implants. We analyzed two surgical approaches to proximal humeral fractures.
  
  
  METHODS
  Between April 2004 and October 2007, 63 consecutive patients with displaced proximal humeral fractures who underwent LPHP osteosynthesis in our institute were classified to two treatment groups retrospectively: the deltopectoral incision and the deltoid-splitting incision according to surgeon's preference. The Constant and Disabilities of the Arm, Shoulder and Hand scores were recorded for clinical assessment. Quality of reduction, fracture union, and radiographic complications were recorded for radiographic assessment. Electrophysiological abnormalities were also assessed.
  
  
  RESULTS
  There were no significant differences between the groups with regard to demographic data, preoperative radiographic findings, and duration of follow-up. There were also no significant differences between the groups with regard to operative time (p = 0.918), blood loss (p = 0.407), hospital stay (p = 0.431), postoperative head-shaft angle (p = 0.769), union time (p = 0.246), final head-shaft angle (p = 0.533), Constant score (p = 0.677), Disabilities of the Arm, Shoulder and Hand score (p = 0.833), radiographic complications (p = 1.000), and presence of electrophysiological abnormalities (p = 0.296). Avascular necrosis of the humeral head was found in three patients, all of whom in the deltopectoral approach group.
  
  
  CONCLUSIONS
  We found no statistically significant difference in clinical, radiographic, and electrophysiological outcomes between the deltopectoral approach and deltoid-splitting approach while surgical treatment of proximal humeral fractures.
authors.affiliation: Department of Orthopedics, E-DA Hospital, Kaohsiung, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chin-Hsien
authors.initials: CH
authors.lastname: Wu
authors.forename: Ching-Hou
authors.initials: CH
authors.lastname: Ma
authors.forename: James Jih-Hsi
authors.initials: JJ
authors.lastname: Yeh
authors.forename: Cheng-Yo
authors.initials: CY
authors.lastname: Yen
authors.forename: Shang-Won
authors.initials: SW
authors.lastname: Yu
authors.forename: Yuan-Kun
authors.initials: YK
authors.lastname: Tu
mesh_terms: D001860:Bone Plates; D004185:Disability Evaluation; D004576:Electromyography; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome