Introduction
Locked plating for complex proximal humerus fractures through a deltopectoral incision can be difficult due to the fracture
morphology and need for fixed angle screws. Although good results have been reported with the deltopectoral approach; technical
difficulties, excessive soft tissue stripping and fears of avascular necrosis have lead to the use of minimal access techniques.
Method
Fifteen patients with three or four part fractures were treated by locked plating through a mini-invasive lateral trans-deltoid
approach. All patients were relatively young with good bone quality and had sustained a high-velocity injury. Initial closed
reduction was attempted in all patients, but majority of the patients (9/15) required open reduction to achieve a satisfactory
reduction.
Results
Union was achieved in all patients. All fractures united with an acceptable alignment. There were no incidences of axillary
nerve palsy. There were no incidences of hardware failure or loss of reduction. There were no incidences of avascular necrosis
at 1-year follow-up. The mean normalized constant score at last follow-up was 85.24.
Conclusion
Locked plating through lateral trans-deltoid incision may offer a better alternative to the deltopectoral approach in these
complex fractures where locked plating is contemplated. It respects the fracture biology, allows ease in placement of the
locking plate and angle stable screws and offers a stable construct with less surgical morbidity.
Keywords Locking plates - MIPO - Proximal humerus fractures - Deltoid splitting