Should a short pin in a posterior humerous fracture always have 2 distal screws

The retrieved evidence does not test whether a short pin in a posterior humerus fracture should always have two distal screws.

The closest study, from 2025, tested antegrade nailing of humeral shaft fractures, not a short pin in a posterior fracture [1]. It found that a 5 cm distance between the fracture and the distal locking screws improved axial and torsional stability, and that using two screws increased compressive stiffness [1]. But that study used a nail, not a short pin, and the fracture was in the shaft, not the posterior humerus. The biomechanics of a short pin in a posterior fracture are different: the working length, the bone quality at the distal fixation site, and the rotational forces are not the same.

No study in this retrieval compared one distal screw versus two for a short pin in a posterior humerus fracture. No study reported rates of nonunion, implant failure, or reoperation for that specific construct. The question is about a specific surgical decision, and the evidence base that was retrieved does not address it.

My call: there is no evidence in this retrieval to support a rule that a short pin in a posterior humerus fracture must always have two distal screws. The decision should be based on fracture stability, bone quality, and surgeon judgment, not on a universal rule. Confidence: low, because the evidence does not cover the question.