Comparative study on management of Neerrsquo;s one part and two part proximal humerus fractures in elderly treated with conservative method versus percutaneous k-wire

Background: Proximal humerus fractures constitute a significant proportion of osteoporotic injuries in the elderly, ranking third in incidence after hip and distal radius fractures. These fractures often result from low-energy trauma and are compounded by factors such as poor bone quality, complex shoulder biomechanics, and patient comorbidities. In resource-limited settings, the financial burden of advanced implants further complicates treatment decisions. As such, the optimal management strategy-whether conservative or surgical-remains a subject of ongoing clinical debate. Objective: The aim of this study was to compare the outcomes of conservative management versus percutaneous K-wire fixation in elderly patients presenting with Neer’s one -part or two-part proximal humerus fractures. Specifically, the study evaluated differences in fracture union time, complication rates, and functional outcomes between the two treatment modalities. Methods: A retrospective, randomized comparative study was conducted involving 30 patients aged 60 years and above with radiologically confirmed Neer’s one-part or two-part proximal humerus fractures [2]. Patients were evenly divided into two groups: Group A received conservative management with a shoulder-arm sling and immobilization, while Group B underwent closed reduction and percutaneous fixation using K-wires. Post-treatment follow-up occurred at scheduled intervals over a six-month period, during which radiographic healing, shoulder function (range of motion and pain), and complications (e.g., infection, malunion, nonunion) were systematically recorded and analyzed. Results: The mean fracture union time in the K-wire group was significantly shorter (22 weeks) compared to the conservative group (36 weeks). Functional recovery, as assessed by range of motion and daily activity level, was also superior in the K-wire group. Only three minor complications were noted in the operative group (two pin tract infections, one malunion), all of which were managed without long-term sequelae. In contrast, seven patients in the conservative group experienced complications, including multiple cases of malunion and nonunion, leading to suboptimal functional recovery in several cases. Conclusion: The findings of this study suggest that percutaneous K-wire fixation offers a reliable, minimally invasive, and cost-effective solution for the management of proximal humerus fractures in elderly patients presenting with Neer’s one -part and two-part fractures. Compared to conservative treatment, it facilitates faster fracture healing, reduces complication rates, and supports improved functional outcomes. Given its low morbidity and affordability, K-wire fixation should be strongly considered in elderly patients, particularly in resource-constrained healthcare environments.