Abstract

COMPARISON OF LATERAL DELTOID SPLITTING AND DELTOPECTORAL APPROACHES IN THE TREATMENT OF PROXIMAL HUMERUS FRACTURES

*Dr. Wali Muhammad, Maj. Gen. Dr. Suhail Amin, Dr. Muhammad Arsalan Azmat Swati, Dr. Zainullah Kakkar, Dr. Adeel Habib and Dr. Zeeshan Aslam

Abstract

Background: The fracture in proximal humerus is a common fracture in older aged people. There are two major methods for management of these fractures i.e. lateral deltoid splitting approach and deltopectoral approach. But which method is more appropriate is still a controversy. Objective: To compare the outcome of lateral deltoid splitting method versus deltopectoral method for management of proximal humerus fracture. Material and methods: This randomized controlled trial was done at the department of Orthopedic Surgery, Combined Military Hospital, Rawalpindi for about 3 months. One hundred and forty cases; 70 in both groups diagnosed with humeral fracture were enrolled and were randomly divided in two groups. In group A, surgery was done by using Deltoid splitting approach. In group B, surgery was done by using deltopectoral approach. Duration of surgery was noted. After surgery, patients were evaluated for infection, hospital stay, range of motion and Constant shoulder score after 3 and 6 months. All the data was recorded in proforma. SPSS v. 22 was used to enter and analyses the data. Results: In Lateral deltoid splitting group, mean age of the patients was 49.60 ± 11.82 years. In Deltopectoral group, mean age of the patients was 49.89 ± 12.37 years. In Lateral deltoid splitting approach, there were 35 (50.0%) male patients and 35 (50.0%) female patients. In Deltopectoral approach, there were 36 (51.4%) male patients and 34 (48.6%) female patients. The mean operative time was 61.91 ± 5.06 min with Lateral deltoid splitting approach and63.63 ± 4.38 min with Deltopectoral approach. Postoperative infection was noted in 2 (2.9%) versus68 (97.1%) patients, respectively. After 6 months, mean range of motion was 150.14 ± 17.55 with Lateral deltoid splitting approach while 132.21 ± 17.86 with Deltopectoral approach (p-value < 0.05). The mean Constant Shoulder score was 86.29 ± 8.59 with Lateral deltoid splitting approach while 75.74 ± 9.11 with Deltopectoral approach (p-value < 0.05). After 6 months, mean DASH score was 24.66 ± 8.45 with Lateral deltoid splitting approach while 30.77 ± 5.77 with Deltopectoral approach (p-value < 0.05). Conclusion: Thus, the outcome of lateral deltoid splitting was significantly better than deltopectoral approaches in the treatment of proximal humerus fractures.

Keywords: lateral deltoid splitting, deltopectoral approaches, proximal humerus fractures, Constant Shoulder score, range of motion.