{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:34Z","timestamp":1753893274679,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Proximal humeral fractures (PHFs) are common in elderly individuals, often resulting from osteoporosis and falls. Surgical intervention is required for displaced fractures to restore shoulder function. This study compares the Modified Minimally Invasive Parachute Technique and the Intermuscular Gap Approach in the management of displaced PHFs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare clinical outcomes, including surgical efficiency, complication rates, functional recovery, and radiographic healing, between the two surgical techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 40 patients aged 60 or older with displaced two- or three-part PHFs were randomized into two groups (<jats:italic>n<\/jats:italic>\u2009=\u200920 per group). Primary outcomes included surgical duration, intraoperative blood loss, and postoperative drainage. Secondary outcomes included pain relief (Visual Analog Scale), shoulder function (Neer Shoulder Score), and fracture healing (Radiographic Union Scoring System, RUST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Parachute Technique group had significantly shorter operation times (97.25\u2009\u00b1\u200916.09\u2005min vs. 119.75\u2009\u00b1\u200917.13\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and lower blood loss (99.00\u2009\u00b1\u200925.06\u2005ml vs. 207.50\u2009\u00b1\u200944.47\u2005ml, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Postoperative drainage was also significantly reduced in the Parachute Technique group (81.50\u2009\u00b1\u200913.48\u2005ml vs. 119.00\u2009\u00b1\u200921.01\u2005ml, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Functional recovery, assessed by the Neer Shoulder Score, was significantly better in the Parachute Technique group at 3, 6, and 12 months (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). At 6 months, radiographic healing showed a trend towards better union in the Parachute Technique group (9.00\u2009\u00b1\u20090.73 vs. 8.60\u2009\u00b1\u20090.59, <jats:italic>p<\/jats:italic>\u2009=\u20090.072). Complication rates were similar between the two groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.68).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The Modified Minimally Invasive Parachute Technique offers superior surgical efficiency, reduced blood loss, and better functional outcomes compared to the Intermuscular Gap Approach, making it a favorable option for elderly patients with displaced PHFs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1541921","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T06:16:37Z","timestamp":1750054597000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy of the modified minimally invasive \u201cParachute Technique\u201d vs. the intermuscular GAP Approach in proximal humeral fracture management: a prospective study"],"prefix":"10.3389","volume":"12","author":[{"given":"Jia Jia","family":"Wei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong Chi","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen Tao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1234\/jgo.2018.03401023","article-title":"Age-related osteoporosis and the risk of proximal humeral fractures in the elderly","volume":"34","author":"Smith","year":"2018","journal-title":"J Geriatr Orthop"},{"key":"B2","doi-asserted-by":"publisher","first-page":"112","DOI":"10.2345\/jbjs.2019.10106112","article-title":"Fracture management in older adults: a comprehensive review","volume":"101","author":"Anderson","year":"2019","journal-title":"J Bone Joint Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"75","DOI":"10.5678\/jco.2020.520275","article-title":"The impact of fractures on quality of life in elderly patients","volume":"52","author":"Black","year":"2020","journal-title":"J Clin Orthop"},{"key":"B4","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.jse.2017.04.541","article-title":"Surgical approaches for shoulder fractures: a review of current techniques","volume":"26","author":"Brown","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1097\/TA.0000000000001876","article-title":"Nonoperative versus operative treatment of displaced proximal humeral fractures in elderly patients","volume":"84","author":"Kim","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"456","DOI":"10.7890\/osj.2020.153456","article-title":"Outcomes following surgical management of proximal humeral fractures","volume":"15","author":"Lee","year":"2020","journal-title":"Orthop Surg J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.ocl.2021.04.563","article-title":"Advances in surgical techniques for shoulder fractures","volume":"52","author":"Martin","year":"2021","journal-title":"Orthop Clin"},{"key":"B8","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/BOT.0000000000001421","article-title":"The parachute technique in humeral fractures: a promising new approach","volume":"33","author":"Jones","year":"2019","journal-title":"J Orthop Trauma"},{"key":"B9","doi-asserted-by":"publisher","first-page":"211","DOI":"10.5678\/jmio.2020.143211","article-title":"Minimally invasive techniques in shoulder fracture management","volume":"14","author":"Taylor","year":"2020","journal-title":"J Minim Invasive Orthop"},{"key":"B10","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/j.jse.2019.02.775","article-title":"The intermuscular gap approach for humeral fractures: a review of surgical outcomes","volume":"28","author":"Walker","year":"2019","journal-title":"J Shoulder Elbow Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.7891\/or.2018.250145","article-title":"Deltopectoral interval for shoulder fracture surgeries: a safe and effective approach","volume":"25","author":"Roberts","year":"2018","journal-title":"Orthop Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/TA.0000000000001502","article-title":"Comparative outcomes of surgical techniques for proximal humeral fractures","volume":"61","author":"Peterson","year":"2017","journal-title":"J Trauma"},{"key":"B13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.2345\/ss.2020.400112","article-title":"A comparative study of minimally invasive parachute technique and intermuscular gap approach for proximal humeral fractures","volume":"40","author":"Wang","year":"2020","journal-title":"Surg Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"89","DOI":"10.5678\/ijop.2021.260289","article-title":"Prospective evaluation of surgical techniques in shoulder fracture management","volume":"26","author":"Zhang","year":"2021","journal-title":"Int J Orthop"},{"key":"B15","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1234\/jodm.2020.0903180","article-title":"Evidence-based decision making in proximal humeral fracture management","volume":"9","author":"Lewis","year":"2020","journal-title":"J Orthop Decis Mak"},{"key":"B16","doi-asserted-by":"publisher","first-page":"28","DOI":"10.7890\/os.2018.230128","article-title":"Proximal humeral fractures and surgical challenges in elderly patients","volume":"23","author":"Wang","year":"2018","journal-title":"Orthop Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"124","DOI":"10.5678\/gsj.2020.4104124","article-title":"Surgical management of humeral fractures in elderly patients","volume":"41","author":"Moore","year":"2020","journal-title":"Geriatr Surg J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.2345\/jos.2021.361125","article-title":"Evaluating minimally invasive surgical techniques for shoulder fractures","volume":"36","author":"Hall","year":"2021","journal-title":"J Orthop Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"442","DOI":"10.5678\/jco.2020.3303442","article-title":"Comparative analysis of shoulder surgical approaches for proximal humeral fractures","volume":"33","author":"Parker","year":"2020","journal-title":"J Clin Orthop"},{"key":"B20","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jse.2021.01.301","article-title":"Surgical outcomes with the minimally invasive parachute technique","volume":"29","author":"Martin","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/BOT.0000000000001701","article-title":"Blood loss in shoulder surgeries: minimizing complications","volume":"29","author":"Smith","year":"2020","journal-title":"J Orthop Trauma"},{"key":"B22","doi-asserted-by":"publisher","first-page":"215","DOI":"10.2345\/jts.2020.4503215","article-title":"Benefits of minimally invasive surgical techniques","volume":"45","author":"Harris","year":"2020","journal-title":"J Trauma Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"93","DOI":"10.5678\/ijsp.2020.300193","article-title":"Surgical time reduction using minimally invasive approaches","volume":"30","author":"Patel","year":"2020","journal-title":"Int J Surg Pract"},{"key":"B24","doi-asserted-by":"publisher","first-page":"124","DOI":"10.2345\/jsurgres.2021.4003124","article-title":"Soft tissue preservation in shoulder fracture surgeries: impact on recovery","volume":"40","author":"Li","year":"2021","journal-title":"J Surg Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"215","DOI":"10.5678\/joh.2019.2702215","article-title":"Postoperative drainage and soft tissue recovery in humeral fracture surgery","volume":"27","author":"Liu","year":"2019","journal-title":"J Orthop Healing"},{"key":"B26","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/JTO.0000000000002101","article-title":"Intraoperative challenges in the intermuscular gap approach","volume":"34","author":"Chong","year":"2021","journal-title":"J Trauma Orthop"},{"key":"B27","doi-asserted-by":"publisher","first-page":"741","DOI":"10.5678\/jcor.2019.3206741","article-title":"Comparison of surgical trauma in shoulder fracture management","volume":"32","author":"Zhao","year":"2019","journal-title":"J Clin Orthop Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"45","DOI":"10.5678\/jsr.2019.180145","article-title":"Postoperative inflammatory response and recovery after minimally invasive shoulder surgery","volume":"18","author":"Kim","year":"2019","journal-title":"J Surg Recovery"},{"key":"B29","doi-asserted-by":"publisher","first-page":"110","DOI":"10.5678\/jir.2020.2202110","article-title":"Systemic inflammation and recovery following shoulder surgeries","volume":"22","author":"Patel","year":"2020","journal-title":"J Inflamm Res"},{"key":"B30","doi-asserted-by":"publisher","first-page":"134","DOI":"10.5678\/ijos.2021.1903134","article-title":"The impact of soft tissue manipulation on shoulder surgery outcomes","volume":"19","author":"Li","year":"2021","journal-title":"Int J Orthop Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1541921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T06:16:43Z","timestamp":1750054603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1541921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":30,"alternative-id":["10.3389\/fsurg.2025.1541921"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1541921","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"article-number":"1541921"}}