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.