Closed retrograde Hackethal nail stabilization of humeral shaft fractures

We retrospectively reviewed 48 consecutive humeral shaft fractures treated with Hackethal stacked, flexible, intramedullary (IM) nails. The indications for fixation were polytrauma or fracture patterns not amenable to bracing. The average age of patients was 40 years. Eight had associated primary nerve injuries. All fractures were reduced closed, and the nails were inserted retrograde through a distal posterior cortical window. Follow-up was possible in 33 patients. Ninety-seven percent (32 of 33) had healed at 1 year. There were no iatrogenic nerve palsies. There was one delayed union, one nonunion, one deep infection, and three occurrences of heterotopic ossification at the entry portal. Two patients with distal nail migration required second operations. Clinical examination showed normal range of motion at the shoulder and an average of 5 degrees loss of extension at the elbow. Hackethal's bundled IM nailing was shown to be a reliable, inexpensive, and relatively atraumatic method for stabilization of simple and comminuted humeral shaft fractures.