Deltoid-split approach versus deltopectoral approach in displaced proximal humeral fracture: A meta-analysis

Objective To compare the efficacy and safety of Deltoid-split approach versus Deltopectoral approach in the treatment of displaced proximal humeral fracture. Methods Articles compared two surgical approaches published in Embase, Pubmed, CNKI, Chinese Biomedical Database, Wanfang Data, Cochrane Library and other well-known databases were retrieved from January 2006 to April 2018. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis. Results A total of 789 patients in 10 controlled studies were included in the meta-analysis. Results showed statistical significance were found in the operation time (95% CI: -26.56-9.77, P<0.00001), intraoperative blood loss (95% CI: -73.79--19.54, P<0.00001], length of hospital stay (95% CI: -1.35--0.60, P<0.00001), constant score 3 month after operation (95% CI: 4.38-6.92, P<0.00001), Activity of daily living (ADL) 6 month and 12 month after operation (95% CI: 0.27-2.02, P=0.01) between two approaches. The constant score at 6 months (95% CI: -1.66-6.74, P=0.24) and 12 months after operation (95% CI: -7.01-7.73, P=0.92), 12 months postoperative ADL (95% CI: -0.18-1.49, P=0.12), DASH (95% CI: -4.91-2.47, P=0.52, complications (95% CI: 0.55-1.34, P=0.51) were not statistically significant. Conclusions The Deltoid-split approach is superior to the deltopectoral approach in the treatment of displaced proximal humeral fracture regards to the operation time, blood loss, length of hospital stay, union time. But there is not enough evidence on the incidence of complications, long term limb function and other aspects. Key words: Humeral fractures; Meta-analysis; Surgical approach