title: Shoulder hemiarthroplasty for proximal humeral fractures: comparisons between the deltopectoral and anterolateral deltoid-splitting approaches.
abstract: BACKGROUND
  Shoulder hemiarthroplasty is a widely accepted method for treating complex proximal humeral fractures, and the deltopectoral approach is the most popular route for this procedure. The purpose of the current study was to define and compare outcomes of shoulder hemiarthroplasty when using deltopectoral or anterolateral deltoid-splitting approaches.
  
  
  METHODS
  Two cohorts of patients were compared for clinical and radiographic outcomes at the same postoperative follow-up periods: a deltopectoral group (DP group) of 15 patients, from November 2004 to April 2007, and an anterolateral deltoid-splitting group (DS group) of 17 patients, from May 2007 to December 2009. Pain scores, goniometric measurements of the range of motion, and Constant scores were recorded for clinical assessment. Radiographic evaluations were recorded for stem osteolysis, tuberosity absorption, joint subluxation, and acromiohumeral distance.
  
  
  RESULTS
  The 2 groups did not differ significantly in demographic data, preoperative fracture classification, surgical timing, early postoperative radiographic findings, and 2-year radiographic results. The DS group had less immediate postoperative pain (P = .025). At the 2-year follow-up assessment, the groups did not difference significantly in shoulder abduction and forward flexion. All prostheses survived until the 2-year assessment.
  
  
  CONCLUSIONS
  When performing shoulder hemiarthroplasty for complex proximal humeral fractures, we found that the anterolateral deltoid-splitting approach provides an easier route for assessing posterior fracture fragments and managing rotator cuff tissue. The anterolateral deltoid-splitting approach was shown to be an acceptable alternative route for shoulder hemiarthroplasty than the standard deltopectoral approach.
authors: Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. enjoycu@ms22.hinet.net
authors: Ying-Chao
authors: YC
authors: Chou
authors: I-Chuan
authors: IC
authors: Tseng
authors: Chih-Wei
authors: CW
authors: Chiang
authors: Chi-Chuan
authors: CC
authors: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D005260:Female; D062785:Hemiarthroplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterolateral deltoid-splitting approach; Level III; Retrospective Comparative Design; Treatment Study; deltopectoral approach; proximal humeral fracture; shoulder hemiarthroplasty