From the Research
The treatment of a proximal humeral fracture using PHILOS plating involves a systematic surgical approach, with the most recent and highest quality study 1 demonstrating excellent functional outcomes and low complication rates. The procedure begins with the patient positioned in the beach chair position under general anesthesia with fluoroscopic imaging available.
- The deltopectoral approach is most commonly used, with an incision starting from the coracoid process extending laterally along the deltopectoral groove.
- After identifying and protecting the cephalic vein, the deltopectoral interval is developed and the cephalic vein is retracted laterally with the deltoid.
- The fracture is exposed by identifying the long head of the biceps tendon as an anatomical landmark.
- Reduction of the fracture is performed using K-wires for temporary fixation, with special attention to restoring the medial calcar support and humeral head-shaft angle. The PHILOS plate is then positioned approximately 5-8mm distal to the greater tuberosity and 2-4mm posterior to the bicipital groove, as supported by the study 1.
- Multiple locking screws are inserted into the humeral head in divergent directions to enhance fixation, with care taken to avoid intra-articular screw penetration.
- Distal fixation is achieved with at least three bicortical screws in the humeral shaft.
- Fluoroscopic confirmation of proper reduction and implant position is essential throughout the procedure. The rotator cuff insertions are repaired if damaged, and the wound is closed in layers. Postoperatively, the arm is immobilized in a sling for 2-3 weeks, followed by progressive rehabilitation starting with pendulum exercises and advancing to active-assisted range of motion at 4-6 weeks, as recommended by the study 1. This technique provides stable fixation through angular stability of the locking screws, allowing for early mobilization while maintaining fracture reduction until healing occurs, with the study 1 demonstrating excellent functional outcomes and low complication rates.