Comment on “Modified Percutaneous Kirschner Wire with Mutual Linking Technique in Proximal Humeral Fracture: A Technique Note and Preliminary Results”

Dear Editor, We have carefully reviewed the article entitled “Modified Percutaneous Kirschner Wire with Mutual Linking Technique in Proximal Humeral Fracture: A Technique Note and Preliminary Results.” by Chang et al.[1] and found it very interesting. While we appreciate the authors’ efforts, we have some questions about certain aspects of the study methodology that we hope they can address. Regarding the “Patients and study design” section,[1] we have two queries. First, was there a significantly higher proportion of dominant hand involvement among included patients, or was there no statistical difference? Second, did patients’ occupations influence their selection for modified percutaneous pinning with the mutual linking technique? This is particularly relevant for heavy laborers, as their greater occupational demands on shoulder strength might lead to worse postoperative outcomes with this fixation method. Concerning the “Inclusion and exclusion criteria” section,[1] which included displaced proximal humerus fractures of AO/OTA classification 11-A through C, we would like to know if additional Kirschner wires were used to fix the humeral head and greater tuberosity in patients with fractures approaching AO/OTA classification 11-C type, given that greater tuberosity displacement is a common postoperative complication in these comminuted fractures. In addition, while Figure 1 demonstrates the use of rubber bands for wire linking to maintain construct stability,[1] we note that a Foley catheter could serve as an alternative,[2] since rubber bands may not be available as surgical materials in every hospital operating room.Figure 1: A Foley catheter could be used as an alternative, as rubber bands may not be available as a surgical material in every hospital operating room (Reproduced from Chang HM, Lin YT, Wang CH, and Chen PC, Formosan Journal of Musculoskeletal Disorders, 2022. Licensed under CC BY-NC-SA 4.0.)Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.