[Intramedullary pinning for humeral diaphysis fractures. A minimal risk osteosynthesis. 82 cases]

This study was designed to evaluate the complication rate of a novel intramedullary pinning technique described in 1988. After 10 years of clinical experience, it was possible to establish a significant difference in terms of healing delay compared with other fixation methods or conservative treatment.

During a 10-year period, a total of 82 fractures, mostly isolated, unstable fractures, were treated. Retrograde intramedullary pinning (RIMP) was used for proximal and midshaft fractures and antegrade pinning (AIMP) for distal fractures. Statistical analysis was used to investigate the role of all parameters that may influence healing delay.

92.7% of the fractures healed in an average time of 9 weeks. Neither location nor fracture type, nor even an intrefragmental gap had any significant influence on healing delay. There were 7 primary axial deviations of more than 10 degrees in which union was achieved and 6 nonunions. These nonunions were mostly proximal fractures and inappropriate fixation. No radial nerve injury, no infection, and no deterioration of the fracture site was observed. There were 27 pin migrations, mainly towards the shoulder, which dit not affect the final anatomic and functional outcome. Functional result was good in 88% of cases. Four algodystrophy syndromes and 6 nonunions induced stiffness, mainly in the shoulder.

Intramedullary pinning using this technique did not induce any severe iatrogenic condition. Healing delay compares favorably with better results of conservative treatment. Improving surgical technique should further minimize disadvantages of this method.

Humeral intramedullary pinning technique has a low complication rate. It is a good compromise between conservative treatment and conventional osteosynthesis. It causes little trauma to the patients, allows stabilization of any fracture site, and delay to bone union is similar to that with conservative treatment.