A comparative study to assess the effect of multiple Kirschner wiring versus plating in the management and functional outcome of proximal humerus fractures

Abstract

<p><strong>Background: </strong>Proximal humerus fractures constitute 5% of all appendicular skeletal injuries and are mainly a menace of the elderly, after hip fractures and distal radial fractures. According to the NEER’S classification, the decision regarding the treatment of such fractures is dependent on whether the four anatomical segments of the proximal humerus are fractured or displaced.</p><p><strong>Methods: </strong>A total of 50 patients admitted in orthopaedics ward satisfying the inclusion criteria were randomly divided in 2 groups with 25 patients in each group for PHILOS plating and Kirschner wiring management. Groups were compared with respect to their improvement in physical function, pain, quality of life, complications and re-operation rates.</p><p><strong>Results: </strong>Out of the total 50 cases, 20% were type I, 22% type II, 36% were type III fractures while 22% were type IV fractures. Mean DASH questionnaire was comparable between two groups at 1 month after surgery (p=0.56). During immediate post-op period and at subsequent follow ups, DASH questionnaire was better in plating group as compared to K-wiring. At 3 months and 6 months follow up, functional outcome as calculated by DASH questionnaire was comparable between two groups (p=0.17 and 0.45). Excellent to good outcome was seen in all cases of either group. No difference was observed between study groups with respect to associated complications. K-wire loosening was observed in 2 cases (8%). Plating was associated with infections (8%) and screw break out (4%).</p><p><strong>Conclusions:</strong> After comparing both the techniques, we recommend PHILOS plating for young adults and percutaneous K wire fixation for the elderly age group.</p>