Distally Cemented Modified Hackethal's Technique in the Management of Humeral Shaft Fractures, Surgical Technique, and Preliminary Results

Introduction: In 1961, Hackethal has introduced the use of multiple stacked flexible intramedullary (TM) rods in the treatment of humeral shaft fractures which is a minimally invasive method, that allowed optimal reduction with the use of IM fixation, opting for biological healing. However, this technique has several limitations that include little control over rotational stability, shortening, pin migration, and irritation of the triceps. Materials and Methods: In this paper, we present our modification of the classic Hackethal's surgical technique by adding cement distally, thus making it a locked IM construct. Results: Preliminary results in 8 patients who underwent modified Hackethal's technique are presented in this paper. This technique shows promising preliminary results at the level of healing, range of motion, rate of complications, cost reduction, and ease of removal of the material. Discussion: This modification allows better and more control in terms of rotation and shortening, especially in comminuted fractures. It also eliminates the risk of pin migration and triceps irritation, with ability to mobilize the shoulder and elbow immediately postoperatively (postop) compared with prolonged immobilization by the classic technique. These factors lead to a better postop function of the elbow and shoulder in addition to a faster recovery and return to activity. To note, the cost of this procedure is very low compared with plate fixation and other IM techniques. This surgical technique is used in patients who are not candidates for conservative treatment, and whose health care plan does not financially cover the cost of plate osteosynthesis or intramedullary nailing. This modified technique is highly cost-efficient, and it emerges as a viable treatment option in selected cases in third world countries, where the luxury of using expensive orthopedic implants is not accessible for many patients.