From the Research
The treatment of a surgical neck fracture using PHILOS plating involves a systematic surgical approach, with the most recent and highest quality study 1 guiding the procedure.
Step-by-Step Procedure
The procedure starts with positioning the patient in the beach chair position under general anesthesia, administering prophylactic antibiotics, and making a deltopectoral approach incision from the coracoid process extending distally along the deltopectoral groove.
- Identify and protect the cephalic vein
- Develop the deltopectoral interval and retract the cephalic vein laterally with the deltoid
- Expose the fracture by identifying the biceps tendon and retracting it medially
- Perform reduction of the fracture, aligning the humeral head with the shaft using K-wires for temporary fixation
PHILOS Plate Placement
- Position the PHILOS plate approximately 5-8mm distal to the greater tuberosity and 2-4mm posterior to the bicipital groove, as supported by studies 2, 3, 4
- Place multiple locking screws into the humeral head in divergent directions to enhance fixation in the osteoporotic bone
- Place shaft screws distally
Postoperative Care
- Confirm proper reduction and hardware placement using fluoroscopic imaging
- Irrigate the wound and perform layered closure with a drain often placed
- Immobilize the arm in a sling for 2-3 weeks
- Start passive range of motion exercises at 2 weeks and active motion at 6 weeks
- Begin progressive strengthening at 8-12 weeks, as recommended by 5 and 1 This technique provides stable fixation through multiple locking screws in the humeral head, allowing for early mobilization while maintaining fracture reduction, which is particularly beneficial in osteoporotic bone where traditional fixation methods may fail, as noted in 2 and 1.