Abstract
BACKGROUND: Proximal humerus fractures (PHFs) are common, especially in the elderly, and optimal surgical management remains debated. This study compares clinical, functional, and radiographic outcomes of deltoid split (DS) vs deltopectoral (DP) approaches in PHFs treated with locking plates. AIM: To evaluate and compare the clinical, functional, and radiographic outcomes-as well as postoperative complication rates-associated with the DS vs the DP surgical approach in the open reduction and internal fixation (ORIF) of PHFs using locking plate constructs. METHODS: A multicenter retrospective study of 120 patients undergoing ORIF for closed Neer type II-IV PHFs between January 2023 and December 2023. Patients were grouped by surgical approach [DS (n = 70), DP (n = 50)]. Outcome measures included Numeric Rating Scale (NRS) for pain, Quick-Disabilities in Arm, Shoulder, and Hand questionnaire (QuickDASH), Constant-Murley score, Short Form Health Survey-12v2, and radiographic alignment. Complication rates were recorded. Statistical significance was defined as P < 0.05. RESULTS: Early outcomes favored the DS group: (1) Lower NRS (3.1 vs 5.9); (2) Higher Constant-Murley (68.2 vs 50.5); and (3) Better QuickDASH (25.4 vs 37.1). Complication rate was lower in the DS group (1.66% vs 5.81%). Radiographic outcomes were comparable. Long-term results were similar between groups. CONCLUSION: While both approaches yield satisfactory long-term outcomes, the DS approach is associated with faster early recovery and fewer complications, supporting its use in selected cases.