MODIFIED DELTOID SPLITTING APPROACH FOR PROXIMAL HUMERUS FRACTURES

O. De Carolis¹, A. De Felice² , V. Belviso², G. Cornacchia³ , C.A. Rella³, L.M. Dell’Aera³ , A. Morizio⁴ , G. Solarino⁵

¹ Orthopaedic and Traumatology Unit, San Giacomo Hospital, Monopoli (Ba), Italy;
² Orthopaedic and Traumatology Unit, San Giacomo Hospital, Monopoli (Ba), Italy
³ Orthopaedic and Traumatology Unit, "San Giacomo" Hospital, Monopoli, Bari, Italy
⁴ Orthopaedic and Traumatology Unit, Policlinico Hospital, University of Bari, Department of Translational Biomedicine and Neurosciences, Bari, Italy
⁵ Orthopaedics University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Department of Translational Biomedicine and Neuroscience, Orthopaedic and Trauma Unit, Bari, Italy

Correspondence to:

Journal of Orthopedics 2025 May-August; 17(2): Ahead of Print
https://doi.org/10.69149/orthopedics/2025v7iss2_3

Received: 16 March 2025 Accepted: 30 April 2025

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Abstract

Reduction and fixation of fractures involving the epiphysis and proximal metaphysis of the humerus often require open surgery. Open shoulder surgery is challenging because the deltoid and rotator cuff musculature surround the joint and, in most approaches, exposure is limited by the proximity and importance of the axillary nerve. Understanding the importance of the deltoid and rotator cuff to glenohumeral function has led to the development of innovative, advanced, and less invasive shoulder approaches. Performing the different variants of deltopectoral and transdeltoid approaches to the glenohumeral joint has other advantages, disadvantages, and risks for each, all of which have techniques to extend and maximize exposure. The ability to perform each of these exposures gives the surgeon the flexibility to address the broadest range of pathologies in the best possible way. In this article, we present a new modified deltoid splitting approach that bypasses the area crossed by the axillary nerve and fully mobilizes it. This allows better visualization of the lateral aspect of the proximal humeral epiphysis required for plate placement. We believe this approach provides better surgical exposure and offers a useful alternative in managing complex multifragmentary humerus fractures.

Keywords: deltoid-splitting approach, proximal humerus fracture, shoulder, traumatology