Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients.

The Hackethal technique of using stacked medullary pins for fixation of humeral shaft fractures is usually associated with relatively little blood loss; in addition, exposure of the fracture site and possible associated muscular trauma are avoided, and the risk of contusion of the radial nerve that may occur in fixation by plate and screws is eliminated. The technique has the additional advantage of accomplishing stable fixation of the fracture, thus allowing early motion of both the shoulder and the elbow. The rate of union in 25 patients with adequate follow-up evaluation was 92%, with a reoperation rate of 14%. This high rate may be decreased further by increased experience. The method proves effective in the stabilization of pathologic fractures.

Dislocation after total hip arthroplasty. Treatment with an above-knee hip spica cast.

A study was undertaken of 32 dislocations occurring during a nine-year period in 25 of 1280 postoperative total hip arthroplasty patients. Dislocations occurred in 0.6% of 1030 primary procedures, 1.6% of 165 conversions of hemiarthroplasties to total arthroplasties, and 20% of 85 revisions of previous total hip arthroplasties. Average time to dislocation was 31 days after primary procedures and 106 days after revisions. Acetabular cup malposition and poor patient cooperation appeared to be the causes of dislocation after primary procedures. Trochanteric absence or compromise was a factor in dislocation after revision. Treatment consisted of 13 closed reduction and 19 open reductions. An above-knee hip spica cast was employed for six weeks following closed or open reduction in 16 patients. These 16 patients have been followed up for an average of 32 months (28-45 months). Only one redislocation has occurred.