STEP by STEP PHILOS
DELTO-PECTORAL APPROACH
"FREIBURG STYLE"

1 / Fracture understanding (CT mandatory), (Interactive 3D colored model): AVN risk evaluation, choice of treatment.

2 / Intra-op patient position. Preoperative C-arm images. Unobstructed X-ray access mandatory.

DRAPING

3 / Arm Position.

4 / Draw landmarks, ID of the cephalic vein, Delto-pectoral split, ID of coracoid as a lighthouse. Open fascia.

5 / Fracture Reduction. Pull sutures through rotator cuff. Long Head of biceps resection. Red fragment is the key fragment.

6 / Fracture retention (K.W.).

7 / X-ray assessment of fracture reduction. Beware of Misleading images.

8 / PHILOS Insertion (delayed insertion of the aiming device).

9 / X-ray assessment of PHILOS position: avoid the groove, correct height. Beware of Misleading images.

10 / Screws insertion. X-ray assessment of screw length. Beware of Misleading images.

11 / Tie the sutures to PHILOS

1 / Fracture understanding (CT mandatory), (Interactive 3D colored model): AVN risk evaluation, choice of treatment.

X-Ray

CT mandatory

Interactive 3D colored model

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2 / Intra-op patient position. Preoperative C-arm images. Unobstructed X-ray access mandatory.

Radiolucent Table

AP

Axial

Example 1 / AP

Axial

Example 2 / AP

Axial

Patient positioning.

DRAPING

3 / Arm position.

This image has a orange overlay layer on top of it. Change the color anytime!

Arm positioning

4 / Draw landmarks, ID of the cephalic vein, Delto-pectoral split, ID of coracoid as a lighthouse. Open fascia.

Surgical approach

5 / Fracture Reduction. Pull sutures through rotator cuff. Long Head of biceps resection. Red fragment is the key fragment.

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The illusion of life from cento lodigiani on Vimeo.

6 / Fracture retention (K.W.).

K.W. Example 1

K.W Example 2

7 / X-ray assessment of fracture reduction. Beware of Misleading images.

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8 / PHILOS Insertion (delayed insertion of the aiming device).

PHILOS insertion without the drill block

Late insertion of the drill block

9 / X-ray assessment of PHILOS position: avoid the groove, correct height. Beware of Misleading images.

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10 / Screws insertion. X-ray assessment of screw length. Beware of Misleading images.

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11 / Tie the sutures to PHILOS

6 / X-ray assessment of fracture reduction. Beware of Misleading images

9 / Screws insertion. X-ray assessment of Screw length. Beware of Misleading images

11-VD-729

11-VI-229

3D COLORED MODELS
AS A TOOL TO FORECAST AVN
14 cases with the red fragment nested into the shaft out of 122 cases in the App and 18 post serie cases (140 in total)

Is there a risk for AVN ?

11-VI-229 / 65 y / PHILOS

YES

NO

YES

NO

YES

NO

NOT AVN /

11-VI-619/ 60y / PHILOS

YES

NO

YES

NO

YES

NO

AVN CONFIRMED /

8 XRAY ASSESMENT OF PHILOS POSITION. AVOID THE GROOVE. BEWARE OF MISLEADING IMAGES
In the following 3 cases:
Rate PHILOS plate position as:
OK / HIGH / LOW

CASE 1

CASE 2

CASE 3