From the Guidelines
The approach used for treating a fracture of the surgical neck of the humerus with a PHILOS locking plate is open reduction and internal fixation. This method is utilized to stabilize the fracture and facilitate proper healing. According to the study published in the Annals of the Rheumatic Diseases 1, open reduction and locking plate osteosynthesis is a common treatment for displaced fractures, although it is associated with considerable complications.
The procedure involves several key steps, including:
- Positioning the patient under general anesthesia in a beach chair position
- Using a deltopectoral approach to access the fracture site
- Reducing the fracture anatomically and positioning the PHILOS plate on the lateral aspect of the proximal humerus
- Inserting multiple locking screws through the plate into the humeral head in divergent directions to enhance fixation stability
- Securing the shaft portion of the plate with additional screws
- Utilizing intraoperative fluoroscopy to confirm proper reduction and implant positioning
Postoperative care typically involves wearing a sling for 2-3 weeks, followed by progressive rehabilitation, including pendulum exercises, active-assisted range of motion, and strengthening exercises. This approach provides angular stability through the locking mechanism between screws and plate, which is beneficial in osteoporotic bone and allows for earlier mobilization to prevent stiffness while maintaining fracture stability during healing. The study by 1 highlights the importance of considering the patient's overall condition, including pre-existing rotator cuff dysfunction, when selecting a treatment approach.
From the Research
Approach for Treating Fracture of the Surgical Neck of the Humerus with a PHILOS Locking Plate
The approach used for treating a fracture of the surgical neck of the humerus with a PHILOS (Proximal Humerus Interlocking Orthopedic System) locking plate can vary. Some studies suggest the following approaches:
- Deltopectoral approach: This approach is commonly used for proximal humeral fractures and provides good exposure of the fracture site 2, 3.
- Deltoid interfascicular approach: This approach is a safe and effective alternative for the treatment of displaced proximal humerus fractures, especially when fixed with a PHILOS plate 4.
- Deltoid-splitting approach: This approach has been compared to the deltopectoral approach in some studies, with no significant differences in clinical, radiographic, and electrophysiological outcomes found between the two approaches 5.
- Lateral trans-deltoid approach: This approach has been used in some cases, particularly for complex proximal humerus fractures, and may offer a better alternative to the deltopectoral approach in these cases 6.
Key Considerations
When choosing an approach for treating a fracture of the surgical neck of the humerus with a PHILOS locking plate, the following factors should be considered:
- Fracture morphology and complexity
- Need for fixed angle screws
- Soft tissue stripping and potential for avascular necrosis
- Ease of placement of the locking plate and angle stable screws
- Surgical morbidity and potential for complications
Complications and Outcomes
The studies reviewed reported various complications and outcomes, including:
- Avascular necrosis of the humeral head
- Varus positioning of the head
- Impingement syndrome
- Secondary screw perforation
- Non-union of the fracture
- Infection
- Good clinical outcomes with the use of the PHILOS plate, provided the correct surgical technique is used 3.