Functional Outcomes of Percutaneous K-Wire Fixation in Proximal Humerus Fractures in the Elderly: A Focused Systematic Review of 10 studies

Functional Outcomes of Percutaneous K-Wire Fixation in Proximal Humerus Fractures in the Elderly: A Focused Systematic Review of 10 studies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Functional Outcomes of Percutaneous K-Wire Fixation in Proximal Humerus Fractures in the Elderly: A Focused Systematic Review of 10 studies Dr Thajesh Ram Nanhaa MBBS This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023338/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Proximal humerus fractures are more common in the elderly, especially due to osteoporosis and low-energy falls. Treatment options range from conservative management to complex surgical fixation. Percutaneous K-wire fixation offers a minimally invasive and cost-effective alternative treatment. Objective This focused systematic review aims to evaluate the functional outcomes, complication rates, and union time following percutaneous K-wire fixation in elderly patients with proximal humerus fractures. Methods A focused systematic review evaluated 10 key studies published between 2010 and 2024. Literature was identified through PubMed, Google Scholar, and manual reference mining. Studies included elderly patients (≥ 60 years) treated with percutaneous K-wire fixation, reporting functional outcomes such as Constant-Murley or DASH scores. Results This focused review synthesized evidence from 10 studies. Across these, percutaneous K-wire fixation yielded good to excellent functional outcomes in elderly patients, especially in two- and three-part Neer fractures. Union occurred in 8–12 weeks in most cases. Complications included pin migration (up to 7%), superficial infections, and rare osteonecrosis. Functional outcome scores ranged from 70 to 90 (Constant score) in most studies. Conclusion Percutaneous K-wire fixation is a valuable treatment option for proximal humerus fractures in elderly patients, particularly in low-resource settings. When appropriately selected, patients can achieve satisfactory function with minimal complications. Proximal humerus fracture K-wire fixation elderly percutaneous fixation functional outcome Figures Figure 1 Introduction Proximal humerus fractures represent approximately 5% of all adult fractures and are particularly prevalent in the elderly due to osteoporosis and increased fall risk. These injuries range in complexity from nondisplaced fractures to comminuted multi-part patterns. The Neer classification system is commonly used to categorize these injuries. Treatment depends on fracture type, bone quality, comorbidities, and functional demands of the patient. Options include conservative management, locking plates, intramedullary nails, hemiarthroplasty and percutaneous Kirschner wire (K-wire) fixation. While locking plate fixation offers rigid stability, it is expensive, more invasive, and associated with soft tissue complications. Percutaneous K-wire fixation is a minimally invasive, inexpensive, and technically simpler procedure. It is particularly suited for selected fracture types (e.g., two- and three-part), especially in elderly patients with low functional demands or high surgical risk. Despite its advantages, concerns remain about pin migration and loss of reduction. This focused systematic review synthesizes evidence from 10 selected studies on functional outcomes and complications of percutaneous K-wire fixation in elderly patients with proximal humerus fractures. Methods Search Strategy A focused literature review was conducted in accordance with PRISMA guidelines, emphasizing 10 relevant studies published between 2010–2024. The databases PubMed and Google Scholar were searched with keywords: “proximal humerus fracture”, “elderly”, “K-wire fixation”, “Kirschner wire”, “percutaneous”. Only English-language studies were included. Inclusion Criteria: As part of this focused search and selection of relevant studies, articles were included if they met the following: Patients aged ≥ 60 years Proximal humerus fractures (2-, 3-, or 4-part) Treated with percutaneous K-wire fixation Functional outcomes reported (Constant-Murley Score, DASH) Minimum follow-up of 3 months Exclusion Criteria: Pediatric or middle-aged patients Conservative management or other fixation techniques only No functional outcome measures reported PRISMA Flow Summary: Records identified: 42 Additional records from manual search: 10 Duplicates/non-relevant removed: 12 Records screened: 40 Records excluded: 29 Full-text assessed: 11 Excluded: 1 Included: 10 Results Across the 10 included studies, this focused review found that percutaneous K-wire fixation yielded good to excellent functional outcomes in elderly patients, especially in two- and three-part Neer fractures. Summary of Included Studies: Study Year N Age (Mean) Fracture Types Score Used Key Findings Dhawan et al. 2013 40 70 2–4 part Constant Good results, minor pin migration Jaura et al. 2014 32 66 2–4 part Constant Comparable to plating; faster recovery Wutphiriya-angkul et al. 2019 56 74 2–4 part Constant Less OR time than plating Singla et al. 2020 22 65 2–4 part DASH Early mobilization successful Nasuruddin et al. 2024 Not reported 70 2-part Biomechanical Stable with multi-planar K-wires Fragility Fx Case Series 2013 24 75 Fragility Constant Better outcomes vs conservative Ring et al. 2012 39 72 2–4 part Constant No osteonecrosis in 2-part fractures Retrospective Series 2023 13 68 2-part DASH 92% functional satisfaction Brunner et al. 2010 60 69 2–3 part Constant High union, low morbidity Innocenti et al. 2013 28 73 Fragility Constant Mean score ~ 87, union in 8 weeks Functional Outcomes: Constant Score: 70–90 DASH Score: 15–25 Union: Radiological union was generally achieved within 8–12 weeks Complications: Pin migration (4–7%) Superficial infection (2–5%) Rare osteonecrosis and No major neurovascular injury was reported. Discussion This review demonstrates that the procedure of percutaneous K-wire fixation is a more reliable and cost-effective treatment for elderly with proximal humerus fractures. Most studies reported satisfactory functional recovery, particularly in two- and three-part fractures. Advantages include shorter surgery, minimal soft tissue disruption, and suitability for frail patients. Drawbacks include lower stability in osteoporotic bone and risk of pin migration. Complex four-part fractures may require plating or arthroplasty. Overall, the technique is especially valuable in resource-limited settings. Limitations include the fact that most included studies were case series with small sample sizes and moderate risk of bias. Follow-up duration and outcome measures varied, limiting direct comparability. Future high-quality randomized trials comparing K-wire fixation with locking plates or arthroplasty are needed. As this was a focused review of 10 studies, the conclusions are limited to the evidence synthesized and should be interpreted in that context. Conclusion Percutaneous K-wire fixation provides favorable outcomes in elderly patients with proximal humerus fractures. It is a safe, minimally invasive, and cost-effective option for selected cases, particularly 2- and 3-part fractures. Close follow-up is essential to monitor for pin site related complications. This technique remains an important tool in orthopedic practice. Declarations Ethics declarations This study is a focused systematic review based entirely on previously published research articles. It did not involve the direct participation of human subjects or the use of non-human vertebrates. Therefore, no new ethical approval or informed consent was required. Other Declarations -Human subjects: Not applicable (systematic review). -Animal subjects: Not applicable. -Conflicts of interest: The author declares no conflicts of interest. -Funding: No funding received. -Acknowledgments: None. References Dhawan B et al (2013) Percutaneous pinning for displaced proximal humerus fractures. J Clin Orthop Trauma. ; PMCID: PMC3543884 Jaura V et al (2014) Evaluation of PHILOS plating vs K-wire fixation. J Clin Diagn Res PMCID:PMC4093541 Wutphiriya-angkul P et al (2019) Percutaneous K-wire fixation versus plating in proximal humerus fractures. Thai J Surg. ; [Abstract available] Link Singla R et al (2020) Functional outcome of percutaneous K-wire fixation in proximal humerus fractures. Int J Orthop Sci. ; [Summary available] Link Nasuruddin H et al (2024) Biomechanical evaluation of K-wire constructs. J Orthop Res PMID:39691140 Aging Clin Exp Res. Fragility fractures in elderly (2013) ; PMID: 23760947 Ring D et al (2012) Intermediate outcomes with percutaneous fixation. J Shoulder Elb Surg PMID:22760391 Retrospective Series. Percutaneous pinning in elderly. Orthop Surg Res (2023) ; PMID: 39881921 Brunner F et al (2010) Humerusblock for Neer fractures. Arch Orthop Trauma Surg PMID:20577070 Innocenti M et al (2013) K-wire fixation vs conservative. J Orthop Trauma PMID:23325969 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7023338","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":504297366,"identity":"d61787c4-26af-4f9f-9fac-953d5becf0bb","order_by":0,"name":"Dr Thajesh Ram Nanhaa MBBS","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLACxgYGBjb5gw0HPgA5bOwEVPPAtPBJMDc+nAHSwkysFjkJ9mZjMI+QFnvpswc/F+6wk2eTbmyTtvm1TZ6PmYHxw8ccPLbw5SVLzzyTbNgmc7BNOrfvtmEbMwOz5MxteLTw8BhI87YxM7YxJAK19NxmBGphY+bFr8X4N29bvT1Yi2XPbXtitJgBbTmc2CaR2GzM8ON2ImEtZ3jMrHnbjie38RxsfNjbcDsZ6MhmvH5h7+Exvs3bVm07v739wYEff24DGc0HP3zEowUVAAOBARJNxIM/pCgeBaNgFIyCkQIA9GJKV3yigG8AAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0008-3976-1356","institution":"Independent researcher","correspondingAuthor":true,"prefix":"Dr","firstName":"Thajesh","middleName":"Ram Nanhaa","lastName":"MBBS","suffix":""}],"badges":[],"createdAt":"2025-07-01 20:19:09","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7023338/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7023338/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89993391,"identity":"090bb716-1022-4865-941d-259bdfa25052","added_by":"auto","created_at":"2025-08-27 07:43:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139740,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"66BC480E3C6342E0AA309051E460C79C.png","url":"https://assets-eu.researchsquare.com/files/rs-7023338/v1/56c4dbf6458e8d7f8cdc0a8b.png"},{"id":89995761,"identity":"953248e5-bf86-40e1-b85c-053d5a78c67b","added_by":"auto","created_at":"2025-08-27 08:00:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":432733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7023338/v1/97924dbc-2516-43bc-b995-b679cc73dbfa.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFunctional Outcomes of Percutaneous K-Wire Fixation in Proximal Humerus Fractures in the Elderly: A Focused Systematic Review of 10 studies\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProximal humerus fractures represent approximately 5% of all adult fractures and are particularly prevalent in the elderly due to osteoporosis and increased fall risk. These injuries range in complexity from nondisplaced fractures to comminuted multi-part patterns. The Neer classification system is commonly used to categorize these injuries.\u003c/p\u003e\u003cp\u003eTreatment depends on fracture type, bone quality, comorbidities, and functional demands of the patient. Options include conservative management, locking plates, intramedullary nails, hemiarthroplasty and percutaneous Kirschner wire (K-wire) fixation. While locking plate fixation offers rigid stability, it is expensive, more invasive, and associated with soft tissue complications.\u003c/p\u003e\u003cp\u003ePercutaneous K-wire fixation is a minimally invasive, inexpensive, and technically simpler procedure. It is particularly suited for selected fracture types (e.g., two- and three-part), especially in elderly patients with low functional demands or high surgical risk. Despite its advantages, concerns remain about pin migration and loss of reduction.\u003c/p\u003e\u003cp\u003eThis focused systematic review synthesizes evidence from 10 selected studies on functional outcomes and complications of percutaneous K-wire fixation in elderly patients with proximal humerus fractures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eSearch Strategy\u003c/p\u003e\n\u003cp\u003eA focused literature review was conducted in accordance with PRISMA guidelines, emphasizing 10 relevant studies published between 2010\u0026ndash;2024. The databases PubMed and Google Scholar were searched with keywords: \u0026ldquo;proximal humerus fracture\u0026rdquo;, \u0026ldquo;elderly\u0026rdquo;, \u0026ldquo;K-wire fixation\u0026rdquo;, \u0026ldquo;Kirschner wire\u0026rdquo;, \u0026ldquo;percutaneous\u0026rdquo;. Only English-language studies were included.\u003c/p\u003e\n\u003cp\u003eInclusion Criteria:\u003c/p\u003e\n\u003cp\u003eAs part of this focused search and selection of relevant studies, articles were included if they met the following:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePatients aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eProximal humerus fractures (2-, 3-, or 4-part)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTreated with percutaneous K-wire fixation\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFunctional outcomes reported (Constant-Murley Score, DASH)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eMinimum follow-up of 3 months\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eExclusion Criteria:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePediatric or middle-aged patients\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eConservative management or other fixation techniques only\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNo functional outcome measures reported\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003ePRISMA Flow Summary:\u003c/h2\u003e\n\u003cp\u003eRecords identified: 42\u003c/p\u003e\n\u003cp\u003eAdditional records from manual search: 10\u003c/p\u003e\n\u003cp\u003eDuplicates/non-relevant removed: 12\u003c/p\u003e\n\u003cp\u003eRecords screened: 40\u003c/p\u003e\n\u003cp\u003eRecords excluded: 29\u003c/p\u003e\n\u003cp\u003eFull-text assessed: 11\u003c/p\u003e\n\u003cp\u003eExcluded: 1\u003c/p\u003e\n\u003cp\u003eIncluded: 10\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAcross the 10 included studies, this focused review found that percutaneous K-wire fixation yielded good to excellent functional outcomes in elderly patients, especially in two- and three-part Neer fractures.\u003c/p\u003e\n\u003cp\u003eSummary of Included Studies:\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStudy\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYear\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge (Mean)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFracture Types\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eScore Used\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eKey Findings\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDhawan et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2013\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e40\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e70\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGood results, minor pin migration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJaura et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2014\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e32\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e66\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComparable to plating; faster recovery\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWutphiriya-angkul et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2019\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e56\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e74\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess OR time than plating\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingla et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2020\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e22\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e65\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDASH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEarly mobilization successful\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNasuruddin et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2024\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot reported\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e70\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2-part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBiomechanical\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStable with multi-planar K-wires\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFragility Fx Case Series\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2013\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e24\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e75\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFragility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBetter outcomes vs conservative\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRing et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2012\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e39\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e72\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo osteonecrosis in 2-part fractures\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRetrospective Series\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2023\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e13\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e68\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2-part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDASH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92% functional satisfaction\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrunner et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2010\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e60\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e69\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;3 part\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh union, low morbidity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInnocenti et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e2013\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e28\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003e73\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFragility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean score\u0026thinsp;~\u0026thinsp;87, union in 8 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFunctional Outcomes:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eConstant Score: 70\u0026ndash;90\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eDASH Score: 15\u0026ndash;25\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eUnion: Radiological union was generally achieved within 8\u0026ndash;12 weeks\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eComplications:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePin migration (4\u0026ndash;7%)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSuperficial infection (2\u0026ndash;5%)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRare osteonecrosis and No major neurovascular injury was reported.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review demonstrates that the procedure of percutaneous K-wire fixation is a more reliable and cost-effective treatment for elderly with proximal humerus fractures. Most studies reported satisfactory functional recovery, particularly in two- and three-part fractures. Advantages include shorter surgery, minimal soft tissue disruption, and suitability for frail patients.\u003c/p\u003e\u003cp\u003eDrawbacks include lower stability in osteoporotic bone and risk of pin migration. Complex four-part fractures may require plating or arthroplasty. Overall, the technique is especially valuable in resource-limited settings.\u003c/p\u003e\u003cp\u003eLimitations include the fact that most included studies were case series with small sample sizes and moderate risk of bias. Follow-up duration and outcome measures varied, limiting direct comparability. Future high-quality randomized trials comparing K-wire fixation with locking plates or arthroplasty are needed.\u003c/p\u003e\u003cp\u003eAs this was a focused review of 10 studies, the conclusions are limited to the evidence synthesized and should be interpreted in that context.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePercutaneous K-wire fixation provides favorable outcomes in elderly patients with proximal humerus fractures. It is a safe, minimally invasive, and cost-effective option for selected cases, particularly 2- and 3-part fractures. Close follow-up is essential to monitor for pin site related complications. This technique remains an important tool in orthopedic practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv class=\"Heading\"\u003eEthics declarations\u003c/div\u003e\u003cp\u003eThis study is a focused systematic review based entirely on previously published research articles. It did not involve the direct participation of human subjects or the use of non-human vertebrates. Therefore, no new ethical approval or informed consent was required.\u003c/p\u003e\u003cp\u003eOther Declarations\u003c/p\u003e\n\u003cp\u003e-Human subjects: Not applicable (systematic review).\u003c/p\u003e\n\u003cp\u003e-Animal subjects: Not applicable.\u003c/p\u003e\n\u003cp\u003e-Conflicts of interest: The author declares no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e-Funding: No funding received.\u003c/p\u003e\n\u003cp\u003e-Acknowledgments: None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDhawan B et al (2013) Percutaneous pinning for displaced proximal humerus fractures. J Clin Orthop Trauma. ; PMCID: PMC3543884\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaura V et al (2014) Evaluation of PHILOS plating vs K-wire fixation. J Clin Diagn Res PMCID:PMC4093541\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWutphiriya-angkul P et al (2019) Percutaneous K-wire fixation versus plating in proximal humerus fractures. Thai J Surg. ; [Abstract available] Link\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingla R et al (2020) Functional outcome of percutaneous K-wire fixation in proximal humerus fractures. Int J Orthop Sci. ; [Summary available] Link\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasuruddin H et al (2024) Biomechanical evaluation of K-wire constructs. J Orthop Res PMID:39691140\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAging Clin Exp Res. Fragility fractures in elderly (2013) ; PMID: 23760947\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRing D et al (2012) Intermediate outcomes with percutaneous fixation. J Shoulder Elb Surg PMID:22760391\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRetrospective Series. Percutaneous pinning in elderly. Orthop Surg Res (2023) ; PMID: 39881921\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrunner F et al (2010) Humerusblock for Neer fractures. Arch Orthop Trauma Surg PMID:20577070\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInnocenti M et al (2013) K-wire fixation vs conservative. J Orthop Trauma PMID:23325969\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Proximal humerus fracture, K-wire fixation, elderly, percutaneous fixation, functional outcome","lastPublishedDoi":"10.21203/rs.3.rs-7023338/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023338/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProximal humerus fractures are more common in the elderly, especially due to osteoporosis and low-energy falls. Treatment options range from conservative management to complex surgical fixation. Percutaneous K-wire fixation offers a minimally invasive and cost-effective alternative treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis focused systematic review aims to evaluate the functional outcomes, complication rates, and union time following percutaneous K-wire fixation in elderly patients with proximal humerus fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA focused systematic review evaluated 10 key studies published between 2010 and 2024. Literature was identified through PubMed, Google Scholar, and manual reference mining. Studies included elderly patients (≥ 60 years) treated with percutaneous K-wire fixation, reporting functional outcomes such as Constant-Murley or DASH scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis focused review synthesized evidence from 10 studies. Across these, percutaneous K-wire fixation yielded good to excellent functional outcomes in elderly patients, especially in two- and three-part Neer fractures. Union occurred in 8–12 weeks in most cases. Complications included pin migration (up to 7%), superficial infections, and rare osteonecrosis. Functional outcome scores ranged from 70 to 90 (Constant score) in most studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePercutaneous K-wire fixation is a valuable treatment option for proximal humerus fractures in elderly patients, particularly in low-resource settings. When appropriately selected, patients can achieve satisfactory function with minimal complications.\u003c/p\u003e","manuscriptTitle":"Functional Outcomes of Percutaneous K-Wire Fixation in Proximal Humerus Fractures in the Elderly: A Focused Systematic Review of 10 studies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:43:52","doi":"10.21203/rs.3.rs-7023338/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d7e8c25-fe54-44ee-bcbb-a180e5a91bcc","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T07:43:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:43:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7023338","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023338","identity":"rs-7023338","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}