Fractures of the proximal end of the humerus are relatively common and account for 4-5% of all fractures. Over time, various fixation systems have been developed, including anglular stable plates, external fixation devices and intramedullary nails; achieving the most anatomical reduction, stable fixation, ensuring faster mobilisation and the complete functional recovery of the shoulder. Our elective choice for proximal humeral fractures treatment, up to 3 or 4 fragments, is IM nailing. Therefore, we focused our efforts on various issues associated with the method in conjunction with Lima Corporate | Trauma and ultimately developed a new proximal humeral IM nail called the Diphos Nail, whose unique design allows for the proximal screws to be placed in two different configurations for simpler and more stable fixation of the humeral tubercles, as compared to similar commercially available nails.
Moreover, we believe that, the problem of proximal screws pulling out/migrating, especially in elderly patients, can be solved by inserting a new polymer (Polyether ether ketone) combined with 30% Carbon fibres, into the proximal part of the nail. Technologically, this new concept enhances the angular stability of the proximal screws and actually prevents them from mobilising. Our preliminary experience with the Diphos Nail has been extremely positive. We found the configuration with the proximo-distal/postero-anterior blocking screw to be particularly useful and innovative, especially for 3-fragment fractures with separation of the greater tubercle. None of the cases treated with the Diphos Nail displayed pull-out/migration of the proximal screws, and the fractures consolidated within the expected time frame.
P. Maniscalco1, MD,
E. Del Vecchio1, MD,
J. D’Ascola2, MD
1 Orthoapedics and Traumatology Division,
Ausl Piacenza (Italy)
2 Orthopaedics and Traumatology Division,
University of Siena, Orthopaedics Clinic (Italy)
