Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. DePuy Synthes companies of

Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance For general information about reprocessing, care and maintenance of Synthes reusable...

Introduction LCP Percutaneous Aiming System 3.5 for PHILOS 2 Surgical Technique Patient Positioning and Approach 5 Product Information Implants 23 LCP Percutaneous Aiming System 3.5 for PHILOS Surgical Technique DePuy Synthes

LCP Percutaneous Aiming System 3.5 for PHILOS. For less invasive surgery at the proximal humerus. The Sleeve System – Screw holes are accessible by sleeve system for percutaneous screw insertion – Outer sleeves snap into the aiming arm for quick assembly and removal – Different drill sleeves for the option of locking and cortex screw insertion – Color-coding facilitates system orientation ᕤ Insertion handle can be used independently from aiming arm Radiolucent aiming arm to enable control view under image intensifier Screw holes are percutaneously accessible by the sleeve system ᕥ Blocked access...

Aiming arm can be used as elongation for insertion handle when turned 180° away from the plate Submuscular insertion and percutaneous fixation The LCP Percutaneous Aiming System 3.5 for PHILOS facilitates submuscular insertion and percutaneous fixation of PHILOS via the transdeltoid approach. The design of the LCP Percutaneous Aiming System 3.5 for PHILOS is opti- mized to reduce the risk of interfering with the axillary nerve during screw insertion. To protect the axillary nerve, screw levels C to F are blocked. Screw holes in these sections cannot be accessed through the aiming arm. A Various...

In 1958, the AO formulated four basic principles, which have In 1958, the guidelines for internalbasic principles, which AO formulated four fixation1,2. become have become the guidelines for internal xation1, 2. Anatomic reduction Anatomic Fracture reduction and xation Fracture reduction and fixation to to restore anatomical relationships. restore anatomical relationships. 1 Early, Early, active mobilization mobilization Early and Early and safe mobilization and mobilization and rehabilitation of the injured part and rehabilitation the injured part the the patient as a whole. and patient as a...

Patient Positioning and Approach Note: For information on fixation principles using conventional and locked plating techniques, please refer to the LCP Locking Compression Plate Surgical Technique (DSEM/TRM/0115/0278). 1 Position the patient Place the patient in the beach chair position on a radiolucent table. A lateral side table is recommended to place the abducted arm and to relax the deltoideus muscle. Ensure the fluoroscope is positioned in a way that allows v isualization of the proximal humerus in two axes (AP and lateral/axial). Prepare the patient’s arm so that it can be mobilized intraoperatively....

1 Reduce fracture and fix temporarily Proper reduction of the fracture is crucial for good bone h ealing and function. In some cases, closed reduction before prepping the patient is beneficial. Reduce the head fragments and check the reduction using image intensifier control. Kirschner wires can be used for reduction as joysticks in the fragments and for temporary fixation. Ensure that the Kirschner wires do not interfere with correct plate placement. Note: The locking screws are not suitable for reduction since they cannot exert compression. The head fragments must be reduced before insertion...

2 Prepare plate position Note: The LCP Percutaneous Aiming System 3.5 for PHILOS is used with the PHILOS plate. Please consult the surgical technique “Philos and Philos long” (DSEM/TRM/0815/0449) for detailed information on the implant and its indications. For optimal plate positioning, insert two positioning Kirschner wires 2–4 mm lateral to the bicipital groove and 5–7 mm below the tip of the greater tubercule. Precaution: Placing the plate too high increases the risk of subacromial impingement. Placing the plate too low can prevent the optimal distribution of screws in the humeral head. 2a...

3 Assemble the PHILOS aiming system Instruments 314.550 Screwdriver Shaft, hexagonal, small, B 2.5 mm, length 165 mm, for Quick Coupling or 03.113.019 Screwdriver Shaft 3.5 Stardrive, T15, long, self-holding, for AO/ASIF Quick Coupling 03.122.006 or 03.122.035 Insertion Handle for PHILOS – Proximal Humeral Plate 3.5, with Connecting Screw, hexagonal socket Handle with Quick Coupling Aiming Arm for PHILOS – Proximal Humeral Plate 3.5 Insertion Handle for PHILOS – Proximal Humeral Plate 3.5, with Connecting Screw, Stardrive T15 Attach the insertion handle to the plate by aligning the stabilization...

The following technique describes insertion of proximal screws through the aiming arm (3). Precautions: –– Intraoperative bending of the proximal portion of the plate is not recommended for maintaining proper alignment between the aiming device and the plate. –– Do not attempt to use the LCP Percutaneous Aiming S ystem 3.5 for PHILOS with longer PHILOS plates. LCP Percutaneous Aiming System 3.5 for PHILOS  Surgical Technique  DePuy Sy

4 Insert plate Slide the plate into the subdeltoid space and along the bone. Always keep the plate in contact with bone. Warning: Do not injure the axillary nerve. The axillary nerve can be palpated at the lower margin of the incision. Precaution: Do not use the insertion handle and the plate for soft tissue retraction or for release or dissection of the deltoid insertion. 11    DePuy Synthes  LCP Percutaneous Aiming System 3.5 for PHILOS  Surgical Tech