Osteosynthesis of three parts valgus-impacted proximal humeral fractures: comparison between deltoid-pectoral approach and minimally invasive transdeltoid

BACKGROUND: Proximal humerus fractures are widespread injuries. They are the third most common non-vertebral fracture pattern in older patients with osteoporotic bone. The treatment of these fractures is often tricky, and indications constantly evolve. Among the various possible surgical options, plate osteosynthesis is the most used. In addition to the traditional deltopectoral approach, a minimally invasive technique (minimally invasive plate osteosynthesis [MIPO]) is introduced. This retrospective case-control study compared these two approaches’ clinical outcomes and complications. METHODS: From June 2015 to June 2020, 36 patients (28 women, 8 men) with a mean age of 62.26 years (range: 41-80) were surgically treated for three parts valgus-impacted proximal humeral fractures. Twenty patients were treated with open reduction-internal fixation (ORIF), while 16 patients were with MIPO. Surgical time, functional scores (the Constant-Murley, the Simple Shoulder Test, and the Disabilities of the Arm, Shoulder, and Hand Scores), ROM and complications were used to compare these two different procedures. RESULTS: Thirty-six patients were available for clinical evaluation at a mean follow-up of 16.03 months (6-33 months). We found three complications in our study, all in patients treated with ORIF. The mean surgery time was 103.53 minutes: MIPO required less surgery time (mean 93.64, range 57-150, SD±26.273) than ORIF via deltopectoral approach (mean 110.45, range 46-255, SD±51.316). The SST, CS and DASH were higher in the MIPO group, but there was not a statistically significant difference. Likewise, no significant differences from a statistical point of view were found in the range of motion values by comparing the two types of intervention. However, patients in the MIPO group have experienced a greater ROM. CONCLUSIONS: Several options are available for the treatment of proximal fractures of the humerus. However, no standardized treatment algorithm based on scientific evidence is currently in the literature. According to the analysis of the results, the surgical treatment of three parts proximal humeral fractures impacted in valgus shows good clinical results. The MIPO technique is safe and offers good clinical outcomes comparable to the traditional technique. A significant superiority of a procedure does not emerge compared to the other in treating this type of fracture.