Abstract

Introduction: Proximal humerus fracture patterns being mainly distributed bimodally differentiating between young male and elderly female patients due to high energy trauma like vehicle accident and osteoporosis respectively. The broad majority of proximal humeral fractures are handled non-operatively but few critical fractures need surgery. The purpose of this study was to describe a modified deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures and to assess its clinical outcomes.
Material And method: Forty consecutive patients with proximal humeral fractures were treated with by using a modified deltoid splitting approach with axillary nerve bundle mobilization. Among forty patient five patients were lost to follow up, thirty-five patients were reviewed in our department and had regular follow up.
Results: The mean age of the study population was (53.97±11.80 years). One patient had clinically detectable sensory deficits in the axillary nerve later improved by physiotherapy. Two patients had implant failure for which revision was done and one patient had superficial infection improved by antibiotic coverage according to culture sensitivity report and one patient had deep infection improved by debridement and higher intravenous antibiotic coverage according to culture sensitivity report. Major complications, such as avascular necrosis of the humeral head and varus collapse at the fracture site, were not observed. The mean visual analog score for patient satisfaction was 9.1 (range, 6–10), and the mean neer scores were 83.46±7.11. Distribution of cases as per neer’s score we have found that most of the cases i.e. 45% belong to good followed by 35% belong to excellent and 7.5% belong to fair outcome.
Conclusion: The use of a modified deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures yielded excellent outcomes. This approach is a useful alternative to the deltopectoral approach.