Surgical Discussion

Patient positioning:  The patient was positioned in the beach chair position, facilitating access to the shoulder and allowing intraoperative fluoroscopic control.

Anatomical surgical approach:  A deltopectoral approach was utilized, beginning with an incision along the deltopectoral groove. This approach allows for minimal disruption of the deltoid muscle and provides excellent exposure of the proximal humerus. Soft tissue damage was assessed as grade 1.

During surgery, the rotator cuff was sutured using FiberWire for later augmentation to the plate. Fracture reduction was achieved under direct visualization and temporarily secured with Kirschner wires. A Synthes Philos plate with 3 holes was selected and applied to the proximal humerus. Locking screws were used to secure the plate, ensuring angular stability. The rotator cuff was then augmented to the plate to enhance stability and facilitate healing.

Postoperative protocol:   Postoperatively, a Medi Armfix sling was applied to immobilize the shoulder and support early rehabilitation.

Follow up:   Not specified

Orthopaedic implants used:   Synthes Philos plate (3 holes), locking screws, FiberWire for rotator cuff augmentation.