THE OUTCOME OF DELTOID SPLITTING APPROACH IN THE MANAGEMENT OF PROXIMAL HUMERUS FRACTURES IN A KASHMIRI POPULATION

Abstract

Background: Proximal humeral fractures are common fractures, accounting for almost 7% of all fractures. Emphasis is placed on complete and accurate diagnosis and formulation of safe and simple standard techniques for fracture realignment, restoration of anatomic stability, fracture healing, rotator cuff integrity, regaining movement and function. The vast majority of undisplaced proximal humeral fractures are treated non-operatively. Surgical treatment is becoming more frequent for displaced proximal humeral fractures. Operative treatment was traditionally done through deltopectoral approach, but recently deltoid splitting approach is gaining favour for treatment of Neers type 2, 3 proximal humerus fractures and posteriorly displaced greater tuberosity fractures.

AIMS AND OBJECTIVES: To assess the efficacy of deltoid splitting approach in the management of proximal humerus fractures (Neer type 2 and 3) in terms of functional and radiological outcome.

STUDY DESIGN: Prospective observational study.

PARTICIPANTS: 25 patients with proximal humerus fractures meeting the inclusion criteria.

METHODS: After seeking approval from Institutional Ethical Committee, this study was conducted on patients attending our emergency department with proximal humerus fractures at SKIMS Medical College Hospital, Bemina, Srinagar from February 2018 to June 2019. Informed and written consent was obtained from all the patients in Urdu language. The functional outcome was assessed at 6 months follow up using the Constant Score.

RESULTS: Mean Constant Score was 77.9 (Good) .32, 60 and 8 % patients had Excellent, Good and Fair grades of Constant score respectively. There were no patients with Poor grade in our study. The mean radiological union time in our study was 12 weeks.

CONCLUSION: This study found that the deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits. The deltoid split­ting approach for plate fixation of 2 and 3-part proximal humeral fractures showed satisfactory postoperative clinical and radiological outcomes.

IMPLICATIONS: Deltoid splitting approach decreasing the chances of vascular disruption to humeral head, thereby decreasing chances of avascular necrosis of humeral head. So, this approach can be widely used as a better alternative to deltopectoral approach in selected patients.