ObjectiveTo investigate the early effectiveness of surgical hip dislocation (SHD) combined with autologous iliac crest bone grafting in the treatment of femoral neck fracture nonunion in adolescents. Methods Between December 2020 and August 2024, 21 adolescent patients with femoral neck fracture nonunion were treated with SHD combined with autogenous iliac bone grafting. There were 16 males and 5 females, aged 15-25 years (mean, 19.1 years). According to the Pauwels classification, there were 8 cases of type Ⅱ fractures and 13 cases of type Ⅲ fractures. After the initial fracture, 18 patients had undergone reduction and internal fixation, while 3 had received conservative treatment. The interval from fracture to the operation was (12.0±9.3) months. Preoperatively, the Harris score was 52.0±4.2, the International Hip Outcome Tool-12 (iHOT-12) score was 45.6±3.2, and the visual analogue scale (VAS) score for pain was 5.1±0.8. Postoperative imaging was reviewed to assess femoral neck fracture healing and whether secondary collapse of the femoral head occurred. The Harris score, iHOT-12 score, VAS score, and complications were evaluated. Results All patients were followed up 12-55 months (mean, 27.7 months). During follow-up, no avascular necrosis of the femoral head, heterotopic ossification, infection, or other complications occurred. At last follow-up, the Harris score, iHOT-12 score, and VAS score were 88.1±4.4, 74.7±5.6, and 1.2±0.6, respectively, all of which significantly improved when compared with preoperative values (P<0.05). In all 21 cases, callus formation was observed at the fracture ends of the femoral neck, with good autogenous bone support and new bone formation in the femoral head and neck, and no collapse of the femoral head was observed. Internal fixator was removed in 5 patients at (25.8±7.1) months postoperatively. ConclusionSHD combined with autologous iliac crest bone grafting has a good early effectiveness in the treatment of femoral neck fracture nonunion in adolescents. The technique not only protects the blood supply of the femoral head, but also fully exposes the structure of the femoral neck fracture, allowing for sufficient freshness, bone grafting, and fixation treatment of the fracture end, thereby achieving good bone healing.
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.