Hackethal bundle nailing with intramedullary elastic nails in the treatment of two- and three-part fractures of the proximal humerus: initial experience at Al Razi Hospital, Kuwait.

Objective: To present the clinical and radiological results of a minimally invasive technique, the fixation of two- and three-part fractures of the proximal humerus according to the Neer Classification System, using the intramedullary bundle-wiring Hackethal technique.

Subjects And Methods: The operations were performed with the Hackethal technique (use of elastic titanium nails, Synthes) on 17 patients (8 males and 9 females) with two- and three-part fractures of the proximal humerus. In cases of two-part fracture only, intramedullary titanium nails were used while for three-part fractures, percutaneous cannulated screws were used to fix the greater tuberosity, followed by intramedullary insertion of titanium elastic nails. The clinical results were assessed using the Constant score and radiological assessment including the union and alignment of the proximal humerus. Preoperative and postoperative CT scans were performed along with 3D reconstruction in all cases for diagnostic and prognostic significance.

Results: All fractures united in an average period of 12 weeks (range 10-17 weeks). In all patients, a good to excellent range of motion of the shoulder, and good to excellent muscular power and alignment were noted. The Constant score amounted to 81 points (range 64-98 points). There was no secondary loss of fixation and migration of implants.

Conclusion: In cases of two-part fracture of the proximal humerus, the minimally invasive Hackethal technique alone and in cases of three-part fracture, the same technique with percutaneous cannulated screws provided excellent clinical and radiological results with a minimal risk of complication. It is an important alternative to open reduction and internal fixation of these difficult fractures.