Percutaneous pinning of the proximal humerus

Percutaneous pinning, which has been recommended for unstable, unimpacted two-part fractures of the proximal humerus, requires satisfactory closed reduction and maintenance of reduction with minimum arm movement. Most surgeons usually keep the image intensifier in the anteroposterior (AP) plane and rotate the arm to obtain a second view. This arm movement may render closed reduction and percutaneous pin fixation difficult. A four-step technique that facilitates closed reduction and percutaneous fixation of unstable fractures of the proximal humerus and permits adequate visualization of the proximal humerus in both the AP and axillary planes is presented.