The Egyptian Orthopaedic Journal Vol. 60, No. 3, 2025 ISSN: 1110-1148 (print) ISSN: 2090-9926 (online) DOI: 10.21608/EOJ.2025.449743 ORIGINAL ARTICLE Modifed Trans-Deltoid Approach for Internal Fixation of Proximal Humeral Fracture Mohamed K. El-Mesery, Mohamed S. Saeid, Muhammad A. Quolquela, El-Sayed M. El-Forse Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt. Correspondence to Mohamed K. El-Mesery, MBBCh, Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Gharbiya, Egypt. E-mail: dr.mohamed.khairy2020@gmail.com Background This sudy evaluates outcomes of internal fxation of proximal humeral fracture using modifed trans-deltoid procedure, focusing on functional results and complications. The conventional delto-pectoral procedure can be challenging for signifcantly displaced fractures, especially the greater tuberosity, and frequently necessitates a thorough dissection of soft tissues. In contras, Trans-deltoid approach ofers easier access but carries a possibility of axillary nerve injury. Patients and Methods A total of 23 patients participated in this prospective trial, both sexes, Neer’s type 2, 3, and 4. Depending on the fracture architecture, either a ‘two-window’ less invasive incision or a longer incision was made using a modifed trans-deltoid technique. Utilizing the Consant–Murley shoulder score, functional results were analyzed. Results Neer’s classifcation categorized fractures as type 2(43.5%), type 3(39.1%), and type 4(17.4%). The mean Consant–Murley score for shoulder function at the las follow-up was 83.7 points, with 4.3% poor, 17.4% moderate, 21.7% good, and 56.5% excellent outcomes. No cases of posoperative axillary nerve palsy were reported. Conclusions The modifed trans-deltoid approach is a practical and simple method for fxing proximal humeral fractures. It ofers an early range of movement, little soft tissue damage, short operative time, better surgical exposure, and adequate accessibility for reduction and implant insertion. Keywords Deltoid splitting approach, Proximal humerus fracture, Trans-deltoid approach. Received: 07 December 2024, Accepted: 04 February 2025 INTRODUCTION A 4–6% of adult fractures are proximal humeral fractures with a 1:2 male to female ratio [1,2]. Older people often have a hisory of low-energy trauma, whereas young individuals typically susain proximal humerus fractures as a consequence of high-energy trauma [3]. The deltopectoral (DP) and trans-deltoid (deltoid splitting) methods are frequently utilized to treat proximal humeral fractures. Nearly all orthopedic specialiss are aware with the delto-pectoral method, that involves accessing the inter-nervous plane between the deltoid and pectoralis major muscles. However, for certain fractures, particularly those where there is greater tuberosity displacement, achieving reduction using that method can be challenging. Additionally, Soft tissues need to be dissected and retracted during plate placement to the lateral surface of proximal humerus [3–7]. The delto-pectoral approach enhances the loss of blood supply to bone fragments and raises the chance of damage to the blood vessels supplying the humeral head, leading to avascular necrosis [3,5,6]. Therefore, accessing from the lateral aspect using the trans-deltoid approach would be much more suitable in some insances [3]. There have been worries about using the trans-deltoid method because of the possibility of harming the axillary nerve, which passes around the humeral surgical neck and via deltoid muscle. Therefore, an additional skipped incision may be required to protect the axillary nerve from harm [8].