Trauma, upper extremity
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Dean G Lorich , Norbert Südkamp
Trauma, upper extremity PHILOS Instrument Upgrade One of the main complications in proximal humeral plating is primary screw perforation. Primary screw perforation happens if too long screws are set at the time of surgery, despite intraoperative image intensifier control. Using measuring notations on drill bits and K-wires seems inadequate for achieving reliable screw length in osteopenic bone. Therefore, dedicated instruments were developed to drill the lateral cortex only, followed by the use of a depth probe to feel the resistance of the subchondral bone in these patients. Additionally, the new proximal suture holes on the PHILOS plate are penetrating the plate from the top to the sides, allowing the attachment of the suture after the plate has been fully mounted to the bone.
3.5 mm LCP Periarticular Proximal Humerus The 3.5 mm LCP periarticular proximal humerus plate is indicated for fractures, fracture dislocations, and nonunion of the proximal humerus—particularly for patients with osteopenic bone. This construct acts as a fixed angle device with divergent and convergent screws offering superior biomechanical properties to improve fixation and pullout strength in osteoporotic bone [1–3]. The plate is positioned more distally (12–15 mm from insertion of rotator cuff) to avoid impingement and more anteriorly distally to lessen the need to elevate the deltoid insertion. The plate is produced in precontoured models. Six suture holes with undercuts allow for passing sutures to help with both reduction and ligament reattachment. Chamfers at the top and bottom edges of the suture holes prevent sharp edges. The plate head features six locking holes that accept 3.5 mm locking screws and two locking “kickstand” screws in the plate neck to direct the screws into the calcar region. The plate shaft has elongated combination holes and accepts 3.5 mm locking and 3.5 mm cortex screws. The second calcar screw can be used for shaft reduction with a nonlocking cortex screw. The cutout in the plate for the cortex screw head is deeper and more rounded for reducing screw head prominence. The tapered plate tip facilitates percutaneous insertion. The plate is available in 2–6, 8, 10, 12, and 14 holes in stainless steel.