Percutaneous fixation of proximal humerus fractures.

Closed reduction and percutaneous fixation is a viable treatment option for displaced two-part, three-part, and valgus-impacted four-part proximal humerus fractures. Despite biomechanical studies demonstrating inferior stability compared with plate and intramedullary nail constructs, percutaneous fixation offers a minimally invasive approach with potential clinical advantages. Decreased scarring, improved cosmesis, and lower rates of avascular necrosis have been reported. Potential complications include pin migration, infection, avascular necrosis, neurovascular injury, and malunion. Clinical outcomes have been comparable with conventional techniques, with studies reporting approximately 70% good to excellent results.