Percutaneous Pinning for Surgical Neck Fracture: Method of Choice—Opposes

This is a broad statement and there is no doubt that in selected proximal humerus fractures percutaneous pinning is superior to plate fixation. However, unstable two- and three-part fractures in young patients may require plate fixation for reliable union. Comminuted higher energy injuries do well with dual-plate fixation. Older patients with four-part fractures are still best treated with hemiarthroplasty with tuberosity osteosynthesis. Percutaneous pinning, while being minimally invasive, is not without complications. Complications, including pin tract infections and subsequent septic arthritis from migration of septic pins, have been reported. In addition, pin migration has been associated with potentially life-threatening complications due to the close proximity to neurovascular structures and the thoracic cavity. Loss of position of fracture fragments in the first several weeks of treatment is not uncommon with pin fixation. Open reduction and internal fixation (ORIF) may be necessary to obtain anatomic reduction and secure fracture fixation. Recent changes in the approach to plate fixation with lateral based incisions and variable angle locking screw fixation have improved ORIF outcomes.