Shoulder hemiarthroplasty for proximal humeral fractures: comparisons between the deltopectoral and anterolateral deltoid-splitting approaches.

Abstract

Shoulder hemiarthroplasty is a widely accepted method for treating complex proximal humeral fractures, and the deltopectoral approach is the most popular route for this procedure. The purpose of the current study was to define and compare outcomes of shoulder hemiarthroplasty when using deltopectoral or anterolateral deltoid-splitting approaches. Two cohorts of patients were compared for clinical and radiographic outcomes at the same postoperative follow-up periods: a deltopectoral group (DP group) of 15 patients, from November 2004 to April 2007, and an anterolateral deltoid-splitting group (DS group) of 17 patients, from May 2007 to December 2009. Pain scores, goniometric measurements of the range of motion, and Constant scores were recorded for clinical assessment. Radiographic evaluations were recorded for stem osteolysis, tuberosity absorption, joint subluxation, and acromiohumeral distance. The 2 groups did not differ significantly in demographic data, preoperative fracture classification, surgical timing, early postoperative radiographic findings, and 2-year radiographic results. The DS group had less immediate postoperative pain (P = .025). At the 2-year follow-up assessment, the groups did not difference significantly in shoulder abduction and forward flexion. All prostheses survived until the 2-year assessment. When performing shoulder hemiarthroplasty for complex proximal humeral fractures, we found that the anterolateral deltoid-splitting approach provides an easier route for assessing posterior fracture fragments and managing rotator cuff tissue. The anterolateral deltoid-splitting approach was shown to be an acceptable alternative route for shoulder hemiarthroplasty than the standard deltopectoral approach.