Treatment of humeral diaphyseal fractures with Hackethal stacked nailing: a report of 33 cases.

Hackethal's technique of stacked intramedullary (IM) nailing was used to treat 43 consecutive acute fractures of the humeral diaphysis. Of these, 6 were lost to follow-up and 4 additional patients were excluded for pathologic fractures. All of the remaining 33 traumatic fractures were followed until union. The average age was 34 years. Mean operative time was 90 min. Usually four or five 2- or 3-mm IM Kirschner wires were introduced in a retrograde manner, through a posterior unicortical window under radioscopic control. Closed reductions were performed in 28 patients, and open reductions were performed in the other five. Time to follow-up averaged 3 years 5 months (range 8 months to 13 years). There were no infections. There were three nonunions (9%), and two nails in 1 patient penetrated the greater tuberosity and one nail migrated distally in another patient. This method of internal fixation is not complicated and causes minimal trauma. It provides good stability at the fracture site and permits early mobilization of patients with excellent functional results.