Are there studies on one vs two distal screws for posterior humerus fractures?

The retrieval still does not contain a study that directly compares one versus two distal screws for posterior humerus fractures.

The 2025 biomechanical study on antegrade humeral shaft nailing remains the closest match [1]. It found that two distal screws increased compressive stiffness compared to one, and that a 5 cm fracture-to-screw distance improved axial and torsional stability [1]. But that study tested a nail in a shaft fracture, not a short pin in a posterior fracture. The mechanics are different: working length, bone quality at the distal site, and rotational forces do not transfer.

No retrieved study reports nonunion, implant failure, or reoperation rates for one versus two distal screws in posterior humerus fractures. The evidence base for this specific construct is absent.

My call: the retrieval does not support a rule that a short pin in a posterior humerus fracture must always have two distal screws. Confidence: low, because the evidence does not cover the specific construct.