• Lukman A K Khan, C Michael Robinson, Elizabeth Will, and Roger Whittaker.
• The Shoulder Injury Clinic, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SU, UK. kashkhan@doctors.org.uk
• Injury. 2009 Feb 1;40(2):181-5.

Background And PurposeThe extended deltoid-splitting approach was developed as an alternative to the deltopectoral approach in the treatment of three- and four-part proximal humeral fractures. The aim of our prospective study was to determine whether this approach was associated with evidence of nerve injury, functional deficits or other complications in these cases, during the first year following reconstruction.MethodsOver a 1-year-period, we treated 14 people (median age 59 years) with open reduction and plate fixation using the extended deltoid-splitting approach. All were prospectively reviewed clinically and radiologically during the first year after surgery. Functional testing involved three scoring systems, spring balance testing of deltoid power, dynamic muscle function testing and, at 1 year, electrophysiological assessment of axillary nerve function.ResultsOf the 14 fractures, 13 united without complications and with comparatively minor residual functional deficits. Of these 13 cases, 1 showed slight neurogenic change in the anterior deltoid but no evidence of anterior deltoid paralysis. In the remaining case, osteonecrosis of the humeral head developed 9 months after surgery and functional scores were poor, but without evidence of nerve injury on electrophysiological testing.ConclusionsThis technique is a useful alternative in the treatment of complex proximal humeral fractures, providing good access for reduction and implant placement without adverse effects.

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