Percutaneous Kirschner wires with mutual linking technique in the management of proximal humeral fracture

Objectives: There are several options for operative treatment of proximal humeral fractures (PHF), including closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF) using plates, screws and intramedullary nails. CRPP is considered a minimally invasive approach, avoiding aggressive surgical dissection as in ORIF and minimizing the risk of humeral head osteonecrosis. However, it has some complications, such as loss of fracture reduction and pin migration. Therefore, in this study, we hypothesized that using a modified technique of percutaneous K-wires with mutual linking would provide better radiological and functional outcomes and avoid the complications associated with the standard CRPP. Methods: A prospective cohort study was conducted over 1 year, during which 30 patients who underwent CRPP of PHF using K-wires with a mutual linking technique were recruited. The primary outcomes were functional shoulder status, as measured by the American Shoulder and Elbow Score (ASES) and the University of California, Los Angeles (UCLA) shoulder score, and radiological union. Results: The mean age was 69.23 years. The mean ASES was 93.27/100, while the mean UCLA shoulder score was 32.87/35 at the 1-year follow-up. The mean abduction angle was 166.67; the mean forward flexion angle was 168.67 at 1-year follow-up. Twenty-eight patients (93.3%) achieved union at 6 weeks. One patient had a pin tract infection and one patient had a loss of fracture reduction. Conclusion: The percutaneous K-wire technique with mutual linking is a reliable method for managing PHF, yielding good functional and radiological outcomes.