Comparison of Functional Outcomes in Angle-Stable Osteosynthesis of Comminuted Fractures of the Proximal Humerus with Those in Percutaneous Kirschner-Wire Fixation: A Prospective Study of Mid-Term
Abstract
To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used.Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques.
Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study.
The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures.
An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.