What type of pinning is typically avoided in patients with a high likelihood for AVN?

In patients with a high likelihood of avascular necrosis (AVN), percutaneous pinning is typically avoided due to the potential for compromise to the blood supply of the bone. AVN occurs when the blood flow to a certain area of the bone is disrupted, leading to bone cell death. When percutaneous pinning is performed, there is a risk of further diminishing the vascularity in already compromised areas, especially in the humeral head during shoulder procedures.

In contrast, other types of fixation, such as intramedullary pinning, external fixation, and open reduction internal fixation, might preserve the vascular supply better or provide stability without significantly affecting the blood supply to the surrounding tissues. Therefore, avoiding percutaneous pinning in these patients is a precautionary measure to prevent exacerbating or hastening the progression of AVN.