Introduction: Approximately 10% of the comminuted and displaced proximal humeral fractures (PHF) occur after high-energy trauma. Surprisingly, despite the vast body of literature on the treatment of fractures, very few papers deal with the high-energy PHFs. The work aims to compare the influence of three surgical techniques on the postoperative functional outcomes in this subgroup.
Material and methods: For one year, a total of 185 patients with PHFs were operated. Of them, 19 (10%) had high-energy fractures. Three techniques were used deltopectoral in 9, transdeltoid in 4, and anterolateral in 5 cases. The types of implants were angle stable locking plates, unipolar prosthesis, and K-wires in one patient, which was excluded from the study. The patients were divided into two groups: conventional (classical) deltopectoral approach, and minimally invasive procedures transdeltoid and anterolateral.
Results: The functional outcomes assessed by Constant-Murley and DASH scores revealed the following results: DPA group - 4 good, 2 fair and 3 poor results, whereas in the minimally invasive approaches there were one excellent, one good, two fair, and five poor (56%) results. In ALA and TDA groups, poor results were observed in 40% and 75%, respectively. The conventional DPA had lower average DASH score (lower disability) and higher CMS score (higher quality of function) than the mini-invasive techniques (57 vs. 77 and 61) and (59 vs. 37 vs. 51), respectively
Conclusion: The minimally invasive approaches to the glenohumeral joint (especially TDA) are associated with a high rate of complications and appear unsuitable in high energy PHFs. Moreover, they not only limit the possibility of optimal reduction of the fracture but also hamper the correct positioning of the implant. The results raise significant concern regarding the effectiveness of the mini-invasive techniques, which warrants future prospective trials with larger sample size.
Key words: proximal humerus, high-energy fractures, surgical approach, functional outcomes
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