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Background  Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. The aim of this study was to evaluate the clinical outcome of MIPPO versus ORIF via the deltoid-pectoralis approach in elderly patients with proximal humeral fractures.    Methods  Thirty-six patients with proximal humeral fractures were enrolled in this study. Following the randomized block and single-blinded principle, the patients were assigned to two groups and treated with either conventional ORIF or MIPPO, both through the deltoid-pectoralis approach. Surgical outcomes were evaluated by the NEER score, Constant-Murley score, blood loss, length of operation, radiological imaging and clinical examination. The patients were followed up for 4–24 (mean 10) months.    Results  According to Constant-Murley score, the surgical outcome was excellent in 14 cases, satisfactory in 2 cases and unsatisfactory in one case in MIPPO group versus 10, 5 and 4 in conventional ORIF group. MIPPO was significantly advantageous over conventional ORIF in terms of NEER score, Constant-Murley, length of operation and intraoperative blood loss. In addition, MIPPO was also more advantageous in several indexes in patients with BMI > 26.0 and NEER type III fracture.    Conclusion  The results of our study have demonstrated that MIPPO through the deltoid-pectoralis approach is an effective alternative for the treatment of proximal humeral fractures in elderly patients.    Trial registration  The trial registration number (TRN):  ChiCTR-INR-17011098  (retrospectively registered at 2017-04-09)

Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures