Cicio C, Longo G, Pavone V, Testa G, Ortuso R, Salvo GC, Ganci M, Prestianni I, Ferrara A, Kory A, Pietropaolo A, Monachino AM, Cuffaro ER, Papotto G. Deltopectoral vs deltoid split approach for proximal humerus fractures treated with locking plate: Our experience. World J Orthop 2025; 16(9): 110859 [DOI: 10.5312/wjo.v16.i9.110859]
Corresponding Author of This Article
Giacomo Papotto, Chief, Director, Department of Surgery, Giovanni Paolo II Hospital, Via Pompei, Sciacca 92019, Italy. giacomopapotto@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2025; 16(9): 110859 Published online Sep 18, 2025. doi: 10.5312/wjo.v16.i9.110859
Deltopectoral vs deltoid split approach for proximal humerus fractures treated with locking plate: Our experience
Calogero Cicio, Gianfranco Longo, Vito Pavone, Gianluca Testa, Rocco Ortuso, Giovanni C Salvo, Marco Ganci, Ignazio Prestianni, Alessio Ferrara, Antonio Kory, Alessandro Pietropaolo, Anna M Monachino, Enrica R Cuffaro, Giacomo Papotto
Calogero Cicio, Ignazio Prestianni, Alessio Ferrara, Anna M Monachino, Enrica R Cuffaro, Giacomo Papotto, Department of Surgery, Giovanni Paolo II Hospital, Sciacca 92019, Italy
Gianfranco Longo, Rocco Ortuso, Giovanni C Salvo, Marco Ganci, Antonio Kory, Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, Catania 95100, Italy
Vito Pavone, Gianluca Testa, Alessandro Pietropaolo, Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Catania 95123, Italy
Author contributions: Cicio C wrote the original draft; Cicio C and Papotto G designed the study; Longo G, Ganci M, Prestianni I, Ferrara A, Pietropaolo A, Monachino AM, Cuffaro ER, and Papotto G participated in the review and editing; Pavone V and Testa G were responsible for developing the methodology; Ortuso R, Salvo GC and Kory A participated in the formal analysis and investigation; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Given the retrospective observational design, which involved the use of anonymized patient data collected during routine clinical care, formal approval from the Institutional Review Board or Ethics Committee was not required under local regulations.
Informed consent statement: No informed consent was required for this study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data is available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giacomo Papotto, Chief, Director, Department of Surgery, Giovanni Paolo II Hospital, Via Pompei, Sciacca 92019, Italy. giacomopapotto@gmail.com
Received: June 17, 2025 Revised: July 17, 2025 Accepted: August 25, 2025 Published online: September 18, 2025 Processing time: 85 Days and 13 Hours
Abstract
BACKGROUND
Proximal humerus fractures (PHFs) are common, especially in the elderly, and optimal surgical management remains debated. This study compares clinical, functional, and radiographic outcomes of deltoid split (DS) vs deltopectoral (DP) approaches in PHFs treated with locking plates.
AIM
To evaluate and compare the clinical, functional, and radiographic outcomes-as well as postoperative complication rates-associated with the DS vs the DP surgical approach in the open reduction and internal fixation (ORIF) of PHFs using locking plate constructs.
METHODS
A multicenter retrospective study of 120 patients undergoing ORIF for closed Neer type II-IV PHFs between January 2023 and December 2023. Patients were grouped by surgical approach [DS (n = 70), DP (n = 50)]. Outcome measures included Numeric Rating Scale (NRS) for pain, Quick-Disabilities in Arm, Shoulder, and Hand questionnaire (QuickDASH), Constant-Murley score, Short Form Health Survey-12v2, and radiographic alignment. Complication rates were recorded. Statistical significance was defined as P < 0.05.
RESULTS
Early outcomes favored the DS group: (1) Lower NRS (3.1 vs 5.9); (2) Higher Constant-Murley (68.2 vs 50.5); and (3) Better QuickDASH (25.4 vs 37.1). Complication rate was lower in the DS group (1.66% vs 5.81%). Radiographic outcomes were comparable. Long-term results were similar between groups.
CONCLUSION
While both approaches yield satisfactory long-term outcomes, the DS approach is associated with faster early recovery and fewer complications, supporting its use in selected cases.
Core Tip: This multicenter retrospective study compares deltoid split (DS) and deltopectoral approaches in proximal humerus fracture fixation with locking plates. While both methods achieved similar long-term results, the DS approach provided superior early functional outcomes and fewer complications. These findings suggest it may be the preferred technique in selected patients, particularly when early recovery is a priority.
