title: Plating of proximal humeral fractures.
abstract: The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.
authors.affiliation: Clinic for Trauma Surgery, Emergency Department, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany. f.martetschlaeger@gmail.com
authors.forename: Frank
authors.initials: F
authors.lastname: Martetschläger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebenlist
authors.forename: Michael
authors.initials: M
authors.lastname: Weier
authors.forename: Gunther
authors.initials: G
authors.lastname: Sandmann
authors.forename: Philipp
authors.initials: P
authors.lastname: Ahrens
authors.forename: Karl
authors.initials: K
authors.lastname: Braun
authors.forename: Florian
authors.initials: F
authors.lastname: Elser
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012784:Shoulder Fractures / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome