3.5 mm LCP Percutaneous Aiming System for PHILOS
Norbert Südkamp, Stefaan Nijs, Ralph Hertel
Fig 1: 3.5 mm LCP percutaneous aiming system for PHILOS. PHILOS is usually implanted through the deltopectoral approach which implicates a long incision and extensive soft-tissue retraction to reach the anatomy of interest. The less-invasive transdeltoid approach is more soft-tissue friendly and gives a better view of the greater tubercle.
The 3.5 mm LCP percutaneous aiming system for PHILOS offers the possibility to insert the PHILOS plate through the transdeltoid approach and to insert the shaft screws percutaneously enabling a less-invasive application of PHILOS.
The system consists of a sleeve system and an aiming arm. It is used analogously to the existing PHILOS aiming instruments and other aiming systems. The aiming arm is radiolucent to allow control under image intensifier. Locking as well as cortex screws can be used through the device. Compression achieved by cortex screws in the shaft may lead to plate tension. The device has to be locked to the plate at both ends to ensure the plate-device alignment.
A safe zone is defined to protect the axillary nerve (screw holes near the axillary nerve are not accessible through the device). Therefore, the elongated plate hole is not accessible through the aiming arm due to the protected nerve zone. However, by abduction of the arm after fixation, these screw holes become accessible.
Overall, the 3.5 mm LCP percutaneous aiming system facilitates plate insertion as well as positioning and adjustment.
A 76-year-old woman suffered a low-energy fall at home.
Case provided by Stefaan Nijs, Leuven, Belgium
Fig 2: Preoperative x-ray. 
Fig 3: PHILOS plate mounted on guiding arm, with suture augmentation in place. 
Fig 4: Preliminary fixation and percutaneous reduction with bone elevator. 
Fig 5: Intraoperative view. 
Fig 6: Intraoperative view of final result. 
Fig 7: Postoperative view. Note the minimally invasive approach. 
Fig 8: Postoperative result. 
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