Treatment of proximal humeral fractures by intramedullary Kirschner wires

This study is a retrospective analysis of a case series of 41 proximal humeral fractures treated by multiple intramedullary Kirschner (K) wires.

Forty-one proximal humeral fractures in patients aged 17 to 62 years were treated by closed intramedullary K-wires. There were 18 patients with the 2-part fractures, 11 with the 3-part fractures and 12 with the 4-part fractures according to Neer's classification. Patients were placed supine on the table, under general anesthesia. The arm was held vertically up by transolecranon traction, and the C-arm was kept parallel to the ground and opposite to the affected arm. A cortical window was created approximately 1.5 cm proximal to the olecranon fossa, by splitting the triceps. Under fluoroscopic control, multiple K-wires were introduced retrograde into the medullary cavity to reach the humeral head across the fracture. The wire tips were kept divergent to provide rotational stability at the fracture site. Postoperatively, the limb was supported in an arm sling. The patients were evaluated for pain, range of motion, strength, anatomic restoration, function of the involved limb, and radiographic union of fracture.

An objective evaluation of the results using Neer's criteria showed 92.7% excellent to satisfactory results. Three patients developed painful shoulder-one from the 3-part and two from the 4-part fracture group. One patient from the 4-part group developed avascular necrosis of the humeral head.

This surgical technique is effective for proximal humeral fractures. It is recommended for routine management of the 2-part and the 3-part fractures. For the 4-part fractures, it can be used in selected, young and active patients. An endoprosthesis is advised for the old, osteoporotic patients.