Kirschner wire-assisted positioning technique reduces operative time and fluoroscopy exposure in proximal humeral PHILOS plate placement: a retrospective comparative study

OBJECTIVE: To compare the efficacy of K-wire-assisted positioning versus conventional freehand palpation in improving intraoperative efficiency (fluoroscopy frequency, operative time, and blood loss) for PHILOS plate placement in elderly patients with proximal humeral fractures. METHODS: This retrospective study included 44 patients aged > 60 years with Neer three- or four-part proximal humeral fractures treated with PHILOS plate fixation via deltopectoral approach (January 2021-June 2024). Patients were divided into freehand palpation (n = 21) and K-wire-assisted (n = 23) groups based on intraoperative technique. Primary outcomes included number of intraoperative fluoroscopies, operative time, and blood loss. Secondary outcomes were postoperative complications and Constant-Murley Score (CMS) at 6 months. RESULTS: Follow-up was completed in 37 patients (84.1%). The K-wire group required significantly fewer fluoroscopies (10.00 ± 1.41 vs. 14.61 ± 4.74 times, p = 0.001), shorter operative time (97.55 ± 7.89 vs. 112.25 ± 7.40 min, p = 0.036), and less blood loss (218.26 ± 40.75 vs. 288.33 ± 46.19 mL, p = 0.001) than the freehand group. No significant differences were found in complication rates (10.5% vs. 27.8%, p = 0.181) or 6-month CMS (76.95 ± 7.98 vs. 76.44 ± 8.68, p = 0.855). CONCLUSION: K-wire-assisted positioning improves intraoperative efficiency by reducing radiation exposure, operative time, and blood loss without compromising functional outcomes or increasing complications. This technique may be particularly valuable for less-experienced surgeons.