Objective To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. MethodsThe clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. Results The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation (P<0.05). ConclusionPHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.
Objective To investigate the impacts of an attending physician-led full-cycle rehabilitation management model based on multi-disciplinary collaboration (integrating anesthesia, rehabilitation and nursing resources) on functional recovery and medical safety in patients undergoing primary unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA) day surgery. MethodsPatients scheduled for primary unilateral THA or TKA at the Department of Orthopedics, Guizhou Provincial People’s Hospital, between April 2024 and March 2025 were included. Participants were randomly allocated to an intervention group or control group using block randomization in a 1:1 ratio. The improvement in Western Ontario and McMaster Universities Osteoarthritis Index total score at 6 weeks postoperatively, successful discharge within 48 hours, rate of unplanned readmission at 30 days and 90 days, Harris Hip Score / Hospital for Special Surgery Knee Score scores, and patient satisfaction, were analyzed in both groups six weeks after surgery. Results A total of 200 patients were enrolled, with 100 cases in each group. Compared with the control group, the intervention group showed greater improvements in Western Ontario and McMaster Universities Osteoarthritis Index scores (32.7±6.4 vs. 26.1±7.2), 48-hour discharge success rate (92.0% vs. 79.0%), 30-day unplanned readmission rate (4.0% vs. 11.0%), 90-day unplanned readmission rate (6.0% vs. 14.0%), 6-week hip function (in the THA subgroup) (42.1±10.3 vs. 34.8±11.5), Knee Society score (in the TKA subgroup) (39.4±9.1 vs. 31.2±10.0), and patient satisfaction (70.2±4.3 vs. 63.5±5.6) (P<0.05). The effective response rate to post-discharge alerts within 48 hours was 95.2%, and the training completion rate was (87.5±9.2)%. No serious complications such as deep vein thrombosis or pulmonary embolism occurred in either group. Conclusion A multidisciplinary, full-cycle rehabilitation model led by the attending physician enables continuous care from pre-hospitalization through post-discharge, promoting better functional recovery and higher discharge efficiency than conventional enhanced recovery after surgery protocols, without increasing safety risks.