[Objective] To compare the clinical efficacy of the lateral deltoid-splitting approach (LDSA) versus deltopectoral approach (DPA) for open reduction and internal fixation (ORIF) of proximal humeral abduction impacted fractures. [Methods] A retrospective study was conducted on 61 patients who underwent ORIF for proximal humeral abduction impacted fractures in our hospital from January 2017 to December 2019. Based on the consequence of perioperative patient-surgeon communication, 34 patients had ORIF performed through the LDSA, while the remaining 27 patients were through the DPA. The perioperative, follow-up and imaging data were analyzed and compared between the two groups. [Results] The patients in both groups had surgical procedures conducted smoothly without serious complications. The LDSA group proved significantly superior to the DPA group in terms of operation time, intraoperative blood loss, total incision length (P＜0.05) , whereas no significant differences were noted between the two groups in intraoperative fluoroscopic frequency, the time to re- sume active motion of the affected limb, incision healing and hospital stay (P＞0.05) . The LDSA group resumed full-weight bearing activity of the involved extremity significantly earlier than the DPA group (P＜0.05) . The VAS score significantly decreased, whereas the forward flexion-backward extension range of motion (ROM) of the shoulder and Constant-Murley score significantly increased over time postopera- tively in both groups (P＜0.05) . The LDSA group proved significantly superior to the DPA group in abovementioned items postoperatively at 1 months and 3 months after operation(P＜0.05) , but there was no significant difference in VAS score, forward flexion-backward extension range of motion (ROM) of the shoulder and Constant-Murley score between the two groups one year after operation (P＞0.05) . With respect to radiographic assessment, the excellent and good rate of fracture reduction quality was 94.12% in the LDSA group, whereas 96.30% in DPA group，which was not statistically significant (P＞0.05) . Bony fracture healing achieved in all patients of both groups with no a statisti- cally significant difference in fracture healing time between the two groups (P＞0.05) . [Conclusion] The LDSA has advantages of less soft tissue damage, fewer complications and earlier functional recovery over the DPA for ORIF of proximal humeral abduction impacted frac- tures