Which scenario would most likely disqualify a proximal humerus fracture from percutaneous pinning?

Which scenario would most likely disqualify a proximal humerus fracture from percutaneous pinning?

• A. 2-part fracture
• B. 3-part fracture
• C. High likelihood of AVN
• D. Low likelihood of AVN

Answer: (C)

The key idea is that the viability of the humeral head drives how you fix a proximal humerus fracture. If the blood supply to the humeral head is at high risk of being lost, fixing the bone with percutaneous pins is unlikely to give a durable, functional result because the head is prone to avascular necrosis and collapse after healing. In fractures where the pattern disrupts the blood supply—typically more complex injuries with articular involvement or four-part fractures—the head’s tissue may already be necrotic or doomed to necrosis regardless of fixation. In such cases, replacing the joint (hemiarthroplasty or reverse shoulder, as appropriate) is a better plan than pinning, which would not address the underlying issue and could fail. Two-part fractures are often suitable for pinning when there’s enough stability and the blood supply remains intact, and even many three-part fractures can be treated with fixation if vascularity is preserved. A low likelihood of AVN would not preclude pinning.

The key idea is that the viability of the humeral head drives how you fix a proximal humerus fracture. If the blood supply to the humeral head is at high risk of being lost, fixing the bone with percutaneous pins is unlikely to give a durable, functional result because the head is prone to avascular necrosis and collapse after healing. In fractures where the pattern disrupts the blood supply—typically more complex injuries with articular involvement or four-part fractures—the head’s tissue may already be necrotic or doomed to necrosis regardless of fixation. In such cases, replacing the joint (hemiarthroplasty or reverse shoulder, as appropriate) is a better plan than pinning, which would not address the underlying issue and could fail.

Two-part fractures are often suitable for pinning when there’s enough stability and the blood supply remains intact, and even many three-part fractures can be treated with fixation if vascularity is preserved. A low likelihood of AVN would not preclude pinning.