[Treatment of complex hand injuries by stable osteosynthesis using a "multiple pinning" technique]

The multiple pinning technique has been reported by the authors as an effective method for the treatment of comminuted osteo-articular fractures of the digits. This procedure can be performed rapidly, offers good stability and thereby allows early post-operative physiotherapy. The aim of this type of management is to offer the patient recovery of thumb to digit pinch by restoring two functional joints (MCP, PIP) or at least one functional joint (MCP), particularly as far as the radial digits are concerned.

After performing reduction, very small diameter pins are introduced and the bone fragments are reconstructed like a puzzle. The very small calibre of the pins allows multiple pinning and simultaneously permits them to be easily orientated. The pins being multiple, and parallel or diverging are responsible for the stability of the construct. The ends of the pins are either bent over or more frequently, just cut flush with the surface of the bone. Comminuted fractures, even the most severe, respond very nicely to this management.

The multiple pinning technique offers remarkable stability, allowing early post-operative physiotherapy. This technique is particularly effective when faced with the difficulties of treating open fractures of the metacarpals and phalanges. Moreover, this technique avoids performing an extensive skin incision. The stability of this multiple pinning technique could be related to the following factors: the shortness of the pins offering more rigidity and less flexibility, the proper fixation of the pins within the cortical bone, especially in the diaphysis and the large number of pins offering more strength. The disadvantage of this technique is the possibility of pin migration.