Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: A systematic review and meta-analysis - 14/03/19

Doi : 10.1016/j.otsr.2018.12.004

Linzhen Xie ^a,^{^{1
These authors contributed equally to this work and should be considered as co-first authors.}}, Yingying Zhang ^b,^{^{1
These authors contributed equally to this work and should be considered as co-first authors.}}, Chunhui Chen ^a, Wenhao Zheng ^a, Hua Chen ^a,^⁎,^{^{2
These authors contributed equally to this work and should be considered as co-corresponding author.}} , Leyi Cai ^a,^⁎,^{^{2
These authors contributed equally to this work and should be considered as co-corresponding author.}}
^a Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, XueYuan West road, 325000 Wenzhou, Luheng District, Zhejiang Province, People's Republic of China
^b Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, XueYuan West road, 325000 Wenzhou, Luheng District, Zhejiang Province, People's Republic of China

^⁎Corresponding author.^⁎⁎Co-corresponding author.

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Abstract

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.

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Keywords : Proximal humerus fractures, Deltoid-split approach, Deltopectoral approach, Humeral head necrosis, Axillary nerve.