Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures
Mehmet Özbey Büyükkuşcu1, Ahmet Kulduk2, Abdülhamit Mısır1, Engin Çetinkaya3, İsmet Yalkın Çamurcu4, Şükrü Sarper Gürsu3
1Department of Orthopedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
2Department of Orthopedics and Traumatology, Fenerbahçe Beko Basketball Team, Istanbul, Turkey
3Department of Orthopedics and Traumatology, Health Science University, Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Turkey
4Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
Keywords: Approach, deltoid, electrophysiology, fracture, proximal humerus.
Objectives: This study aims to investigate the effects of deltopectoral and anterolateral acromial approaches commonly used in open reduction-internal fixation of proximal humeral fractures on the clinical outcomes, and axillary nerve damage through electrophysiological assessment.
Patients and methods: Forty-eight patients (22 males, 26 females; mean age 47.9±13.2 years; range, 22 to 73 years) diagnosed with Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type 11 proximal humeral fractures who underwent osteosynthesis with anatomical locking plates in our hospital between January 2015 and June 2016 were prospectively examined. The patients were divided into two groups according to either the deltopectoral or anterolateral deltoid-split surgical approach used. Clinical outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Constant-Murley scores (CMS) obtained at three- and 12-month follow-up visits. Needle electromyography (EMG) was performed for the electrophysiological assessment of the deltoid muscle.
Results: There were no significant differences between the groups in terms of demographic data, follow-up times, and complications. DASH scores and CMS obtained postoperatively at three months (p=0.327 and p=0.531, respectively) and 12 months (p=0.324 and p=0.648, respectively) revealed no significant differences. In addition, the two groups did not significantly differ with respect to the presence of EMG abnormalities (p=0.792). Avascular necrosis of the humeral head was detected in only two patients from the deltopectoral group.
Conclusion: Deltopectoral and anterolateral approaches do not differ regarding the presence of postoperative EMG abnormalities and functional outcomes. Surgeons can thus adopt either approach. However, dissection without damaging the soft tissue should be performed in both approaches.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.