Comparison of percutaneous pinning with Kirschner wires and internal fixation with anatomical proximal humeral plates for proximal humeral fractures

Abstract

Aim: The treatment of proximal humeral fractures is a controversial issue. The aim of this study was to compare clinically and radiologically the results of two surgical treatment methods for proximal humeral fractures. Material and Methods: Between January 2010 and January 2016, 32 consecutive patients with a diagnosis of displaced proximal humeral fracture who underwent surgical treatment were evaluated retrospectively. The fractures were classified as two-, three-, and four-part fractures according to the Neer system. Sixteen patients were treated with closed-reduction percutaneous pinning and 16 patients were treated with open-reduction internal fixation with proximal humerus anatomical plates. The results were compared clinically using the Constant-Murley shoulder outcome score (CS) and radiologically with direct roentgenograms. Results: The CSs of the Kirschner wire (K-wire) and plate groups did not differ significantly (P = 0.696). The mean CS values were 76.56 ± 19.11 for the K-wire group and 73.56 ± 15.91 for the plate group. No case of avascular necrosis (AVN) and three cases of partial loss of reduction occurred in the K-wire group. In the plate group, two cases of AVN and no case of loss of reduction occurred. All fractures in both groups healed, with no need for revision surgery in either group. Conclusion: The clinical and radiological results of the plate and K-wire groups were similar. Percutaneous fixation has the advantage of minimal invasiveness, which lowers the rate of complications. Closed reduction with K-wire application is a good alternative, especially for two- and three-part fractures of the proximal humeral surgical neck.