Functional outcome evaluation of Neer’s two part and three part proximal humeral fractures treated by percutaneous K-wire fixation in a tertiary care hospital in North India: a prospective study of 21 patients
Keywords:Proximal humeral fracture, K-wire, Constant score, Visual analogue scale
Background: The treatment of proximal humeral fractures is controversial. The advantages of percutaneous Kirschner’s wire (K-wire) fixation include preservation of periosteal blood supply, minimal blood loss, less soft tissue damage and shorter hospital stay. The aim of this study was to evaluate the 2 part and 3 part proximal humeral fractures in terms of functional outcome at final follow up.
Methods: This was a prospective study of 21 patients aged 20 to 60 years with mean age of 44.2 years including two part and three part proximal humeral fractures based on Neer’s classification, treated by percutaneous K-wire fixation. Functional outcome was assessed by Constant-Murley score at 1 year follow up.
Results: On the basis of Neer’s classification, 13 patients had 2 part fracture, 8 patients had 3 part fracture. Radiological union was achieved within 7 to 15.2 weeks, with an average of 11.6 weeks. The mean constant score at 1 year follow up was 78.2, range (42 to 96). In the present study, complications were seen in 8 (38.1%) patients. The results were in proximity with the existing literature.
Conclusions: Percutaneous fixation is minimally invasive technique with preservation of periosteal blood supply, minimal blood loss, less soft tissue damage, surgery can be done under brachial plexus block, less chances of avascular necrosis, shorter hospital stay, no hardware in situ, thus no hardware symptoms, leaves no surgical scar and lowers the rate of complications.
Court–Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.
Baron JA, Barret JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18(3):209-13.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71.
Neer II CS. Displaced proximal humerus fracture. Part II. Treatment of 3 part and 4 part fracture displacement. J Bone Joint Surg. 1970;52-A:1090-103.
Einarsson F. Fractures of the upper end of the upper end of the humerus: discussion based on the follow-up of 302 cases. Acta Orthop Scand Suppl. 1958;32:1-215.
Tanner MW, Cofield RH. Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res. 1983;179:116-28.
Jaberg H, Warner JJ, Jakob RP. Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am. 1992;74:508-15.
Muncibi F, Paez DC, Matassi F, Carulli C, Nistri L, Innocenti M, et al. Long term results of percutaneous fixation of proximal humerus fractures. Indian J Orthop. 2012;46:664-7.
Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am. 2003;85-A(9):1647-55.
Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br. 2001;83(6):799-804.
Zyto K, Kronberg M, Brostrom LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 1995;4:331-6.
Freund E, Nachman R, Gips H, Hiss J. Migration of Kirschner wire used in the fixation of a subcapital humeral fracture, causing cardiac temponade: Case report and review of literature. Am J Forensic Med Pathol. 2007;28:155-6.
Siegel J, Dines D. Proximal humerus malunions. Orthop Clin North Am. 2000;31:35-49.
Wijgman AJ, Roolker W, Pall TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fracture of the proximal part of the humerus. J Bone Joint Surg. 2002;84:1919-2.
Bogner R, Hübner C, Matis N, Auffarth A, Lederer S, Resch H. Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br. 2008;90(12):1602-7.
Neer II CS. Displaced proximal humerus fractures. Part I: classification and evaluation. J Bone Joint Surg Am. 1970;52:1077-89.
Constant CR, Murley AHG. A clinical method of functional assessment of shoulder. Clin Orthop Rel Res. 1987;214:160-4.
Jensen MP. Interpretation of visual analogue scale ratings and change scores. J Pain. 2003;407-14.
Gerber C, Worner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg (Br). 2004;86(60):848-55.
Jagiasi JD, Patel MR, Bochare A, Daliya SG. Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate. Int J Res Orthop. 2018;4(5):736-40.
Vijay A, Kumar M, Bhaskar SK, Rao BS, Gandhi M. Comparison of open reduction internal fixation with proximal humerus interlocking system and close reduction and pinning with K-wire in proximal humeral fracture. J Orthop Traumatol Rehabil. 2017;9:99-105.
Bansal V, Sohal HS, Bhoparai RS. Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications. Int J Orthop. 2015;2(2):317-22.
Patel V, Dwivedi M. Open reduction and internal fixation in proximal humerus fractures by proximal humerus locking plate: A study of 60. Int J Orthop Sci. 2018;4(4):78-83.
Shiva, Sundar S, Rai D. Functional Outcome of Two Part and Three Part Proximal Humerus Fractures –A Comparative Study Between K-Wire And Plate Fixation. J Dent Med Sci. 2015;2:48-58.
Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313(10):1037-47.
Kelkar RY, Mundra A. Evaluation of functional outcomes of a modified technique for percutaneous pinning of proximal humerus fracture. Int J Orthop Sci. 2018;4(2):108-10.
Herscovici D, Saunders DT, Johnson MP, Sanders R, DiPasquale T. Percutaneous fixation of proximal humeral fractures. Clin Orthop Relat Res. 2000;(375):97-104.
Yadav U, Bharth N, Vignesh VR, Chakrawarty A. A comparative study of functional outcome following philos plating versus percutaneous pinning in proximal humerus fractures. MedPulse Int J Orthop. 2020;16(2):18-26.
Keener JD, Parsons BO, Flatow EL, Rogers K, Williams GR, Galatz LM. Outcomes after percutaneous reduction and fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2007;16:330 8.
Daljit S, Mohd Y, Ashwini S. Three and four part fractures of proximal humerus Is percutaneous K wire fixation a good option. J Orthop. 2010;7:11.
Jaura G, Sikdar J, Singh S. Long term results of PHILOS plating and percutaneous K wire fixation in proximal humerus fractures in the elderly. Malays Orthop J. 2014;8:4-7.
Varaprasad G, Kumar V. Three Part Proximal Humerus Fracture Fixation with K-wires Vs Minimally Invasive Locking Plate. Int J Sci Res. 2015;2319-7064.
Soni R, Patel A, Patel V, Jha A, Golwala P. Study of outcomes of the proximal humerus fractures treated by various modalities. Int J Orthop Sci. 2018;4(1):41-4.
Bozkurt C, Sarikaya B, Sipahioglu S, Ergun M, Altay MA, Isikan UE. Comparison of percutaneous pinning with Kirschner wires and internal fixation with anatomical proximal humeral plates for proximal humeral fractures. Ann Med Res. 2018;25(4)673-7.