[Application of PHILOS plate through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures].

OBJECTIVE: To study clinical effects of PHILOS (proximal humeral internal locking system) plates through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures. METHODS: From March 2006 to August 2010, 22 patients with proximal humeral fractures were treated with PHILOS plates through mini-open deltoid-splitting approach. According to Neer classification, 6 cases were type II, 15 cases were type III and 1 case was type IV. Through the anterolateral approach to the shoulder, anterolateral vertical incision of 4 cm length was perforrmed from 1 cm under acromion, and separated deltoideus muscle vertically to touch the fracture,reduced the end of fracture directly and indirectly. PHILOS plate was inserted downward into anterolateral surface of humerus through deltoideus muscle, the distal end and proximal end was fixed by locking screws. The Neer score for shoulder function was evaluated within 1 year after operation. RESULTS: The operative time ranged from 30 to 70 minutes with an average of 45 minutes. No blood transfusion was required during the operation, and all incisions healed in stage I. All the patients were followed up, and the duration ranged from 6 to 18 months with a mean time of 12.5 months. All the fractures healed up perfectly, and the union time ranged from 6 to 12 weeks. According to Neer criteria for shoulder joint function, 10 patients got an excellent result, 9 good, 2 poor and 1 bad. There were no complications such as axillary nerve injuries, screw loosening, steel plate breakage, dislocation of shoulder joint and necrosis of humeral bone. CONCLUSION: PHILOS plate through mini-open deltoid-splittin approach for the treatment of proximal humeral fractures has follow advantages: simple recover,minor-injuries and small tissue invasion, which is an ideal method to treat proximal humeral fractures.

[Radial artery recurrent branch of styloid process bone flap transfer for treatment of scaphoid nonunion].

OBJECTIVE: To investigate the clinical efficacy of radial artery recurrent branch of the styloid process bone flap transfer for treatment of scaphoid nonunion. METHODS: From 2002 to 2007, 18 patients with scaphoid nonunion included 12 males and 16 females with an average age of 31.2 years old ranging from l8 to 51 years. Time from injury to operation was 8 to 26 months (averaged 12.5 months). Radial bone flap blood supply by radial artery recurrent branch of styloid process was embedded in retrograde scaphoid shift distance at both ends, Kirschner wire fixed on the bone flap and bone fractures, and the radial styloid process was resected. Cast gypsum immobilization in a neutral place of wrist were performed for 6 to 8 weeks, the rehabilitation of physical therapy and functional exercise were performed after removal. Kirschner wire were removed after X-ray showed fracture healing. RESULTS: Among them, 15 cases were followed-up for from 8 to 25 months (means 13 months). All fractures healed. The healing time was 8 to 12 weeks. According to adult forearm fracture evaluation of Anderson the results were excellent in 14 cases, good in 1. CONCLUSION: The radial artery recurrent branch of styloid process bone flap has a wealth of blood circulation, can make free grafting of the creeping substitution process directly into the healing process.