Does the Surgical Approach (Deltoid-Split Versus Deltopectoral) Have an Impact on Long-Term Outcomes After Locking Plate Fixation of Proximal Humerus Fractures in the Elderly?

Background/Objectives: Unfavorable outcomes after locking plate fixation of geriatric proximal humerus fractures impair arm function and put social independence at risk. At short-/medium-term follow-up, comparable results have been demonstrated between deltoid-split (DS) and deltopectoral (DP) approaches, while few studies reported superior function in favor of either DP or DS. However, long-term results in comparison are lacking. The aim of this study is to evaluate the long-term influence of surgical approaches in locking plate fixation of geriatric proximal humerus fractures. Methods: N = 39 patients (age 69.00 y (IQR 21); 25 females, 14 males) were finally included in this monocentric retrospective investigation and divided into DS and DP subgroups (baseline population n = 88, n = 49 lost to follow-up). Demographics and injury-/surgery-related data were retrieved. Constant–Murley Score (CS), DASH and Subjective Shoulder Value (SSV) were recorded. Descriptive/explorative statistical analysis was performed, and group differences were evaluated (significance level p < 0.05). Results: The distribution of demographics and injury-/surgery-related data was comparable between DS and DP. The length of stay and duration of surgery did not differ (p > 0.05). Follow-up was assessed at 80.18 ± 7.77 mo (min 60.00 mo). The complication/revision rate was 12.8%. Neither CS nor DASH differed between DS (CS: 73.50 (IQR 42.00; 95% CI: 51.00–87.00); DASH: 15.65 (IQR 28.60; 95% CI: 9.40–18.50)) and DP (CS: 69.00 (IQR 20.00; 95% CI: 63.00–83.00); DASH: 17.10 (IQR 14.50; 95% CI: 8.40–22.90); CS: p = 0.950; DASH: p = 0.786), and SSV was measured equally (p = 0.344). Conclusions: The choice of surgical approach (DS versus DP) did not show a significant influence on long-term outcome after locking plate fixation of geriatric proximal humerus fractures in this study. The results regarding short-/medium-term follow-up are confirmed. Depending on the surgeon’s preference and experience, both approaches seem to represent viable alternatives for humeral head-preserving surgical management. Future studies utilizing larger, adequately powered cohorts are required.