In 1970, Neer first proposed the Neer classification of proximal humeral fractures. The traditional pectoralis major deltoid approach was often adopted with satisfactory results for the proximal humeral fracture requiring surgery. In recent years, with the concept of minimal invasion and rapid rehabilitation, the trans-deltoid lateral approach has been gradually accepted by more and more surgeons, but there are still some controversies on the selection of the two surgical approaches.

To compare the clinical efficacy of locking plate internal fixation by pectoralis major deltoid approach and trans-deltoid lateral approach in treating proximal humerus fracture.

A retrospective analysis was performed on 143 patients with Neer type II and type III proximal humeral fractures treated with locking plate fixation in the department of orthopedic and traumatology of the first bethune hospital of Jilin University from January 2018 to October 2022. According to the different surgical approaches, they were divided into pectoralis major deltoid group and trans-deltoid lateral group. The operative time, incision length, and Constant-Murley score of shoulder joint function at the last follow-up were recorded.

For Neer type II and type III fractures, the trans-deltoid lateral group had more operation time and incision length advantages than those of the pectoralis major deltoid group, and the difference was statistically significant (P<0.05) . However, at the last follow-up, there was no significant difference in the Constant-Murley score between the pectoralis major deltoid group and the trans-deltoid lateral group (P>0.05) .

In treating Neer type II and type III proximal humeral fractures, the trans-deltoid lateral approach has the advantages of smaller incision, shorter operation time, and faster postoperative recovery compared with the pectoralis major deltoid approach. Still, there is no difference in long-term clinical efficacy.