CORR Insights^®: Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Excerpt

The number of proximal humeral fractures is increasing steadily along with the incidence of osteoporosis, and these fractures now represent the third most common fracture in the elderly [3]. Although 80% of these fractures can be adequately managed nonoperatively, displaced fractures require some type of reduction and fixation [5]. Surgical management is challenging due to both biologic and biomechanical factors. Several tendons attach to the proximal humerus, and their unopposed pull on individual fracture fragments leads to displacement that often defies closed management. The proximal humerus has a rich but vulnerable blood supply, which must be carefully protected during open reduction. Avascular necrosis of the humeral head represents a complication due to vascular damage either from the fracture itself or surgery to fix it. Osteoporosis often limits the success of devices to gain fixation in the proximal fragment in this region. Although there are a myriad of fixation devices available, recent studies have demonstrated good results with locking plates [1, 7, 9, 14], locking rods [17], various percutaneous pin techniques [10, 12], and even suture fixation [6]. The variety of hardware options and techniques suggests there is no single best approach for many proximal humerus fractures, and that we still have much to learn about how to manage patients with these injuries. …