Jaberg et al. report outcomes from 48 patients treated with closed reduction and percutaneous Kirschner-wire pinning for unstable proximal humerus fractures — those reducible by manipulation but not maintainable without fixation — at a mean 3-year follow-up, asking whether this minimally invasive approach can match or outperform open fixation techniques.
When you see an unstable proximal humerus fracture that reduces adequately on the table but won't hold — particularly in a patient where preserving humeral head vascularity is the priority.
Percutaneous pinning with at least 3 widely spaced AO pins to subchondral bone is a validated option, but recognize its contraindications: metaphyseal comminution, diaphyseal extension, head-splitting, and irreducible displacement all require a different strategy.
Jaberg et al. report outcomes from 48 patients treated with closed reduction and percutaneous Kirschner-wire pinning for unstable proximal humerus fractures — those reducible by manipulation but not maintainable without fixation — at a mean 3-year follow-up, asking whether this minimally invasive approach can match or outperform open fixation techniques.
When you see an unstable proximal humerus fracture that reduces adequately on the table but won't hold — particularly in a patient where preserving humeral head vascularity is the priority.
Percutaneous pinning with at least 3 widely spaced AO pins to subchondral bone is a validated option, but recognize its contraindications: metaphyseal comminution, diaphyseal extension, head-splitting, and irreducible displacement all require a different strategy.