Intramedullary pinning for humeral shaft fracture: results of a novel technique in 82 cases

Purpose This study was designed to evaluate the complication rate of a nove l intramedullary pinning technique described in 1988. After 10 years of cli nical experience, it was possible to establish a significant difference In terms of healing delay compared with other fixation methods or conservative treatment. Materials and Methods During a 10-year period, a total of 82 fractures, mos tly isolated, unstable fractures, were treated. Retrograde intramedullary p inning (RIMP) was used for proximal and midshaft fractures and antegrade pi nning (AIMP) for distal fractures. Statistical analysis was used to investi gate the role of ail parameters that may influence healing delay. Results 92.7 % of the fractures healed in an average time of 9 weeks. Neith er location nor fracture type, nor even an intrefragmental gap had any sign ificant influence on healing delay. There were 7 primary axial deviations o f more than 10 degrees in which union was achieved and 6 nonunions. These n onunions were mostly proximal fractures and inappropriate fixation. No radi al nerve injury, no infection, and no deterioration of the fracture site wa s observed. There were 27 pin migrations, mainly towards the shoulder, whic h dit not affect the final anatomic and functionnal outcome. Functionnal re sult was good in 88 % of cases. Four algodystrophy syndromes and 6 nonunion s induced stiffness, mainly in the shoulder. Discussion Intramedullary pinning using this technique did not induce any s evere iatrogenic condition. Healing delay compares favorably with better re sults of conservative treatment. Improving surgical technique should furthe r minimize disadvantages of this method. Conclusion Humeral intramedullary pinnning technique has a low complication rate. It is a good compromise between conservative treatment and conventio nnal osteosynthesis. It causes little trauma to the patients, allows stabil ization of any fracture site, and delay to bone union is similar to that wi th conservative treatment.