MODIFIED TRANDELTOID APPROACH VS THE DELTOPECTORAL APPROACH. A COMPARATIVE STUDY IN FRACTURES OF THE PROXIMAL HUMERUS

O. De Carolis¹, A. Benedetto², A. De Felice³ , V. Belviso³, A. Pulcrano⁴ , G. Solarino²

¹ Orthopaedic and Traumatology Unit, San Giacomo Hospital, Monopoli (Ba), Italy;
² Orthopaedics University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Department of Translational Biomedicine and Neuroscience, Orthopaedic and Trauma Unit, Bari, Italy
³ Orthopaedic and Traumatology Unit, San Giacomo Hospital, Monopoli (Ba), Italy
⁴ Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, Orthopaedic and Traumatology Unit, AOU General Hospital of Bari, Bari, Italy

Correspondence to:

Journal of Orthopedics 2024 September-December; 16(3): 135-144

Received: 2 August 2024 Accepted: 15 September 2024

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Abstract

Proximal humerus fractures often require open reduction and internal fixation using plates and screws. This study compares the deltopectoral approach (DP) and the modified transdeltoid approach (MDS) in 54 patients, evaluating clinical and radiographic outcomes, operative time, and complications. Clinical outcomes, assessed with the Constant-Murley Score and VAS scale, were comparable between the two approaches at 1, 3, and 6 months. Postoperative pain improved progressively, with no significant differences between groups. However, operative time was significantly shorter for the MDS group (65 ± 5 minutes) compared to the DP group (92 ± 4.3 minutes). Complications, such as malunion, avascular necrosis, and screw penetration, were minimal and showed no significant differences between approaches. Importantly, no neurovascular injuries were observed in any patients. In conclusion, DP and MDS approaches are safe and effective for treating proximal humerus fractures. The MDS provides a notable advantage in reduced operative time, making it a valuable alternative, particularly for fractures involving the posterior humerus. The choice of approach should consider fracture type and surgeon experience. Further research is needed to validate these findings.

Keywords: deltoid-splitting approach, deltopectoral approach, proximal humerus fracture, shoulder, traumatology