Comparative Study on Management of Proximal Humerus Fractures in Elderly Treated with Conservative Method Versus Percutaneous K-Wire
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N\AAbstract
Introduction
Managing proximal humerus fractures in elderly patients remains a challenge for orthopedic surgeons due to the complex nature of these injuries. Factors such as deforming muscular forces, osteoporosis, and limited financial access to advanced fixation techniques complicate treatment. Multiple approaches, including locking plates, non-locking plates, conservative methods, and percutaneous K-wire fixation, have been used. This study focuses on assessing the effectiveness of percutaneous K-wire fixation compared to conservative management in treating these fractures.
Aim
To evaluate and compare the clinical and functional outcomes of proximal humerus fractures in elderly patients treated with conservative methods versus percutaneous K-wire fixation.
Methodology
The study included 30 patients aged 60 years and above, with fractures classified using Neer’s system. The participants were divided into two groups:
Group A: Treated conservatively with a shoulder immobilizer and discharged on the same day.
Group B: Treated surgically with Closed Reduction Internal Fixation (CRIF) using percutaneous K-wires, with K-wire removal at six weeks post-operation.
Patients were followed up for 3 weeks, 3 months and 6 months. Outcomes such as fracture union, functional status, morbidity, and complications were recorded.
Discussion
Patients treated with K-wire fixation showed an average union time of 22 weeks and with only 3 patients having faced experienced only complications viz (malunion, pin tract infections, pin tract loosening. In contrast, the conservative management group had an average union time of 36 weeks, with seven complications, including malunion and non-union. The K-wire fixation method proved to be cost-effective, less invasive, and associated with shorter recovery times, making it a highly advantageous treatment option.
Conclusion
K-wire fixation outperforms conservative management for proximal humerus fractures by ensuring better reduction, stability, and faster union. It is minimally invasive, suitable for comorbidities and osteoporosis, and enables early mobilization. Patients achieve superior functional outcomes at 6 months, greater satisfaction, and improved quality of life, making it a preferred, effective treatment option.
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References
Fazal, M. A., & Haddad, F. S. (2009). PHILOS plate fixation for displaced proximal humeral fractures. Journal of Orthopaedic Surgery, 17(1), 15-18.
Handoll, H. H., & Brorson, S. (2015). Interventions for treating proximal humeral fractures in adults. The Cochrane Database of Systematic Reviews, (11), CD000434.
Olerud, P., Ahrengart, L., Ponzer, S., Saving, J., & Tidermark, J. (2011). Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. Journal of Shoulder and Elbow Surgery, 20(5), 747-755.
Zyto, K., Ahrengart, L., Sperber, A., & Törnkvist, H. (1997). Treatment of displaced proximal humeral fractures in elderly patients. Journal of Bone and Joint Surgery. British Volume, 79-B(3), 412-417.
Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: A review. Injury, 37(8), 691-697.
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