Purpose: To investigate the evidence of deltoid-split approach (DS) versus deltopectoral approach (DP) in treatment of proximal humerus fractures from current RCT and prospective literatures. Methods: The electronic literature database of Pubmed, Embase, and Cochrane library was searched at December 2017. The data complications (including implant failure, humeral head necrosis, infection, radiological adverse events, nonunion rate, subacromial impingement, and damage of the axillary nerve), functional outcomes (including Constant, NEER, DASH, ADL, VAS score), operation time, hospital stay and intraoperative blood loss were extracted and analyzed by STATA 11.0 software. Results: Three RCTs and three prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the DS group had a significantly low humeral head necrosis rate and short operation time. No significant difference was found in total complication rate, functional outcome, and other Perioperative parameters between DS and DP groups. Conclusion: The prospective evidence suggested that DS approach for proximal humerus fractures had less humeral head necrosis and short operation time than DP approach. Both DS and DP approach had similar results in functional outcomes, total complication, VAS, and hospital stay.
Xie, L., Zhang, Y., Chen, C., Zheng, W., Chen, H., & Cai, L. (2019). Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: A systematic review and meta-analysis. Orthopaedics and Traumatology: Surgery and Research, 105(2), 307–316. https://doi.org/10.1016/j.otsr.2018.12.004