2. PROXIMAL HUMERUS SURGICAL TECHNIQUE
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PROXIMAL HUMERUS SURGICAL TECHNIQUE
MAT Medical Advanced Technology |
SMALL FRAGMENT
LOCKING INSTRUMENT
SET OVERVIEW
4. PROXIMAL HUMERUS SURGICAL TECHNIQUE
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INDICATIONS
I. Proximal Humerus Plate Short Plate Version
• Dislocated fractures of the proximal humerus (2, 3 and 4), including fractures involving osteopenic bone
• Pseudarthroses
• Osteotomies
II. Proximal Humerus Plate Long Plate Version
• As for short version, but for fractures extending to the shaft or without medial support
6. PROXIMAL HUMERUS SURGICAL TECHNIQUE
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PATIENT
POSITIONING
Step 1
Plate position
The correct plate position is between 5-8 mm distal to the top
of the greater tuberosity.
Aligned the plate along the axis of the humeral shaft slightly
posterior to the bicipital grove (2-4 mm).
SURGICAL TECHNIQUE
Place the patient in the supine position on a radiolucent table.
Ensure the fluoroscope is positioned in a way that allows visualization
of the proximal humerus in two axes (AP and lateral/axial).
Prepare the patient’s arm so that it can be mobilized intraoperatively.
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PROXIMAL HUMERUS SURGICAL TECHNIQUE
MAT Medical Advanced Technology |
SURGICAL TECHNIQUE
Step 3
Fix plate to the humeral head to drill holes
Use an appropriate sleeve (3‐3406) to drill holes for the hume-
ral head screws.
Note: Do not drill through the subchondral bone and into the
shoulder joint.
Notes to step 3
Avoiding intra-articular screw placement
Screws that penetrate the humeral head may significantly
damage the glenoid cartilage.
Primary penetration occurs when the screws are initially
placed.
Secondary penetration is the result of subsequent fracture
collapse.
Drilling into the joint increases the risk of screws becoming
intra-articular.
Step 2
Drill block fixation
Fix the drilling block (Block‐PHMA‐M) to the plate.
Plate fixation
Insert the K‐wires (004‐0310‐016) through drill sleeve (3‐3406)
8. PROXIMAL HUMERUS SURGICAL TECHNIQUE
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SURGICAL TECHNIQUE
Step 5
Insert screw
Pre-drill the hole.
Insert the screw.
Take care to guide direction of the screw. In osteoporotic bone
the screw may not follow the pre drilled hole.
Step 4
Determine screw length
Check with the depth gauge whether the sub‐chondral bone
is intact.
Ensure that the screw stays within the humeral head.
Choose a screw slightly shorter than the measured length.
Step 6
Number of screws and location
Commonly 5 screws are placed. Place as many screws as
required into the humeral head, bone quality should be con-
sidered.
In osteoporotic bone a higher number of screws may be
required.
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PROXIMAL HUMERUS SURGICAL TECHNIQUE
MAT Medical Advanced Technology |
SURGICAL TECHNIQUE
Step 8
Insert additional screws into the humeral shaft
Insert one or two additional bi-cortical screws into the humeral
shaft.
All K-wires may now be removed.
Step 7
Calcar screws,
are recommended in all varus displaced fractures, especial-
ly, if there is medial comminution as this adds mechanical
stability.
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78576 Emmingen-Liptingen | Germany
Phone: +49 7465 909-188 ∙ Fax : +49 7465 909-024
www.mat-medical.com · info@mat-medical.com
REV. 12.06.2017
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