title: [Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures].
abstract: BACKGROUND
  Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method.
  
  
  METHODS
  Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores.
  
  
  RESULTS
  It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p>0.05).
  
  
  CONCLUSIONS
  Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.
authors.affiliation: Department of Orthopaedics and Traumatology, İnönü University Faculty of Medicine, Malatya, Turkey. fatih.korkmaz@inonu.edu.tr.
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Korkmaz
authors.affiliation: Department of Orthopaedics and Traumatology, Kolan International Hospital, İstanbul, Turkey.
authors.forename: Mehmet Nuri
authors.initials: MN
authors.lastname: Erdem
authors.affiliation: Department of Orthopaedics and Traumatology, İnönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karakaplan
authors.affiliation: Department of Orthopaedics and Traumatology, İnönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Gökay
authors.initials: G
authors.lastname: Görmeli
authors.affiliation: Department of Family Physcian, İnönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Engin Burak
authors.initials: EB
authors.lastname: Selçuk
authors.affiliation: Department of Radiology, İnönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Maraş
authors.affiliation: Department of General Surgery, Malatya State Hospital Ministry of Health, Malatya, Turkey.
authors.forename: Turgay
authors.initials: T
authors.lastname: Karataş
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D057645:Deltoid Muscle / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000453:epidemiology* / Q000601:surgery; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult