Operative Treatment of Proximal Humeral Fracturedislocations Through an Anterolateral Deltoid Split Approach



Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse, Chur, Switzerland



Background: Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracture
treatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique through
an anterolateral deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patient
reported functional outcome and complications.
Methods: A single center cohort study was performed. All patients operated through a deltoid split approach for PHFD
between 2009 and 2016 were eligible for inclusion. The primary endpoint was subjective shoulder function measured with
QuickDASH and subjective shoulder value (SSV). Secondary endpoints were complications and implant-related irritation.
Results: 28 patients were included. The mean age was 49 (SD ± 10.3). The mean follow-up was 48 months (SD ±
23.7). The mean QuickDASH score was 6.8 (SD ±7.8) and the mean SSV was 86 (SD ±14.6). Four patients had a
conversion into a reversed arthroplasty (14%), one patient (4%) a shortening of secondary perforated screws, four
patients an early re-osteosynthesis (14%), four patients (14%) developed an AVN and in one patient damage of the
axillary nerve was observed. 21 patients (75%) had their implant removed.
Conclusion: Patient reported functional results after humeral head preservation and internal fixation of PHFDs through
an anterolateral deltoid spilt approach are promising. However, there is a high rate of re-operations either because of
complications or for implant removal. Comparing our data to literature these rates are not depending on the approach chosen.
Level of evidence: IV