Year : 2013  |  Volume : 1  |  Issue : 1  |  Page : 14-17

Difference between radiological and functional outcome with deltoid-splitting approach versus deltopectoral approach for the management of proximal humeral fractures with philos plate

Department of Orthopaedic, King George's Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Shah Waliullah
Department of Orthopaedic, King George's Medical University, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-2585.117382

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Background: Proximal humeral fractures are one of the common fractures of upper extremity. Good results by various studies have been reported for proximal humeral locking plate (PHILOS) fixation in proximal humeral fractures. We want to evaluate whether it is only the implant which has given good results or different surgical approach utilized for fixation of plate also affects result. Materials and Methods: A total of 57 patients with proximal humeral fractures were divided in two groups, in Group A, patient's classical deltopectoral approach utilized, while in Group B deltoid-splitting approach was used. All patients were managed by PHILOS plate fixation. Cases were followed up clinically as well as radiologically at 4-6 weeks after operation and thereafter at 10-12 weeks and then at 6 monthly for long-term complications. Functional outcomes of patient were accessed in terms Constant Scoring System, while radiological evaluation was done by taking x-rays to access quality of reduction and union of fracture. Results: All patients were followed for a minimum of 18 months. In Group B, reduction of tuberosities was better in 3 part and 4 part fractures. Mean Constant score in Group A at the end of 3 months was 56, while in Group B it was 62 and statistically significant (P = 0.02). At the end of 18 months, mean Constant score in Group A was 79, while in Group B it was 81 and statistically insignificant (P = 0.72). One patient in Group B showed axillary nerve paresis in postoperative period and recovered at the end of 3 months. Conclusion: We recommend that deltoid-splitting approach can be used in 3 part and 4 part complex proximal humeral fractures and in posterior fracture dislocation shoulder, which are difficult to approach with deltopectoral approach; however, care should be taken while inserting calcar screw in PHILOS plate fixation to avoid iatrogenic axillary nerve injury.

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