Radiographic outcomes of a standardized versus conventional reduction technique in proximal humerus fractures: a matched cohort study.

BACKGROUND

Displaced proximal humerus fractures are common in the elderly and often challenging to reduce anatomically, particularly in comminuted or osteoporotic bone. Variability in surgical approaches and fixation techniques contributes to inconsistent reduction quality and clinical outcomes. A standardized step-by-step reduction technique using temporary transhumeral K-wire retention has been proposed to improve reproducibility, but comparative evidence remains limited. The aim of this study is to compare radiographic outcomes between a standardized stepwise reduction technique and a non-standardized method in proximal humerus fractures and to determine whether the standardized approach is associated with improved anatomical reduction and medial calcar reconstruction.

METHODS

In this single-center, retrospective matched-pair study, 72 patients with proximal humerus fractures treated with open reduction and internal plate fixation between January 2018 and June 2025 were analyzed. Thirty-six patients underwent the standardized reduction and temporary transhumeral K-wire retention technique (Group 1) and 36 underwent the conventional (nonstandardized) technique (Group 2). Patients were matched by fracture type using the Mayo Clinic-Fundación Jiménez Díaz classification and sex. The primary end point was assessed using a 3-item composite checklist (head-shaft displacement, head-shaft alignment, and cranialization of the greater tuberosity), along with separate evaluation of medial support. Associations between surgical technique and outcomes were assessed using ordinal logistic regression for surgical reduction score; logistic regression for medial calcar reconstruction; and linear regression for change in neck-shaft angle (NSA), adjusted for age.

RESULTS

Group 1 was associated with significantly higher odds of achieving a superior reduction score compared with Group 2 (odds ratio = 11.88, 95% confidence interval: 3.97-97.0, P < .001), indicating a substantially increased likelihood of anatomic alignment. Medial calcar reconstruction was significantly more frequent in Group 1 (odds ratio = 4.85, 95% confidence interval: 1.41-16.89, P = .013). No significant difference in the change in NSA was observed between techniques (P = .56), with both groups demonstrating similar mean pre-operative and post-operative NSA.

CONCLUSION

The standardized reduction and retention technique was associated with higher radiographic reduction scores, more frequent medial calcar reconstruction, and more consistent post-operative alignment. These findings suggest improved radiographic reproducibility, particularly in complex or osteoporotic fractures. Prospective multicenter studies are needed to determine whether these radiographic differences translate into improved clinical and functional outcomes.