[Percutaneous pinning for proximal humerus fractures]

Proximal humerus fractures are relatively frequent. The are several possibilities for fixation of proximal humerus fractures: close reduction and fixation with percutaneous pinning or intramedullary rod, open reduction and fixation with tension band or a plate. Close reduction and percutaneous pinning have the advantage to be an easy technique, with good results and it is considered to be ideal in young patients with two-part fractures. The number and the directions of the pins depend upon the number of fragments displaced, reducibility, bone quality, patient age, other pathology associated. Some authors consider being enough the placement of 2 or 3 ascending pins, while others recommend at least 4 pins, ascending and descending. Usually we prefer the techniques in witch are used 3 ascending pins. The operative technique is presented. The most common intra-operative complication in percutaneous pinning is the possibility of damaging the adjacent neuro-vascular structures or tendons. Post-operative complications which may occur are: loosing reduction, pins migrations, aseptic necrosis of humeral head, pins infection. In conclusion percutaneous pinning for proximal humerus fractures it is an easy technique with good results. In this manner are avoided large incisions to the shoulder with can lead to aseptic necrosis of the humeral head. This technique can be used in young patients, with good bone quality, but also in elderly patients, with osteoporosis and other pathology associated. In some three or four-part fractures some reduction problems can occur, but this are rare in two-part fractures.