الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The proximal humeral fractures are increasing in their incidence over time with the increasing life expectancy of the population . they occur with high energy trauma in the young individuals, and with low energy trauma in the elderly osteoporotic individuals. In cases of non or minimally displaced fractures, the conservative management stands out, but in cases of severely displaced, varus angulated, and intraarticular fractures, the surgical management with its varieties come into view.
Open reduction and internal fixation by PHILOS plate for the proximal humeral fractures is the management which is adopted in this study. The deltopectoral approach is the most widely used by most of the orthopedic surgeons. Other orthopedists prefer the transdeltoid approach, and here comes the debate, which of both give the best functional outcome, less soft tissue damage, shortest operative time with more ease and comfort in reduction and application of the implant on its optimum place, and finally which of them offer the least possible complications.
This study included forty patients with two or more part fractures of the proximal humerus, with ages ranging between 40 and 65. They were divided randomly into two groups , twenty patients in each by alternating manner.
The group A patients had their ORIF through transdeltoid approach, the patients had a mean age of 54.8 years ranging from 42 – 64. twelve patients (60%) were males and eight (40%) were females. thirteen patients (65%) had two part fracture, five patients (25%) had three part fracture, and two patients (10%) had four part fracture, seven patients (35%) have associated diseases (diabetes/ hypertension).
The group B patients had their ORIF through deltopectoral approach, the patients had a mean age of 55.9 years ranging from 44.0 – 65.0. eleven patients (55%) were males and nine patients (45%) were females. nine patients (45%) had two part fracture , eight patients (40%) had three part fracture, and three patients (15%) had four part fracture, four patients (20%) have associated diseases ( diabetes/ hypertension ).
The average follow-up period was at least six months. The results were assessed radiologically and clinically. Standard shoulder X-ray series were done postoperatively and during follow-up at intervals of 6 and 12 weeks then monthly till achieving full fracture union. Clinical assessment was done at the end of follow up period through UCLA (university of California and los angels) score.