A cohort study of minimally invasive plate osteosynthesis combined with an enhanced recovery after surgery in the treatment of proximal humeral fractures.

BACKGROUND

This cohort study investigated the efficacy of minimally invasive plate osteosynthesis combined with an enhanced recovery after surgery in the treatment of proximal humeral fractures (PHF).

METHODS

This retrospective study examined 72 patients with PHF treated from March 2019 to June 2021. All patients were divided into two groups: a control group undergoing minimally invasive plate osteosynthesis (MIPO) and a study group receiving MIPO combined with an enhanced recovery after surgery (ERAS). Outcomes compared included operative time, intraoperative blood loss, hospital length of stay, time to first feeding, time to first flatus, and time to initial mobilization, postoperative pain (VAS), functional recovery (Barthel index), and fracture healing rates. The impact of ERAS on MIPO outcomes in patients with PHF was then analyzed.

RESULTS

The study group demonstrated superior healing outcomes compared to the control group (P < 0.05). Post-treatment pain, significantly decreased in both groups, with the study group exhibiting lower scores (P < 0.05). After treatment, the Constant-Murley score of the study group was higher than the control group at one week, three months, and six months after operation (P < 0.05). Hospital stays were significantly shorter in the study group, as were times to first feeding, flatus, mobilization, and fracture healing (P < 0.05). After treatment, Barthel index scores improved in both groups, with the study group achieving higher scores at final evaluation. Conversely, the study group reported lower scores in physical, social, and cognitive health function (P < 0.05) indicating a greater degree of quality-of-life.

CONCLUSION

This study showed that combining minimally invasive plate osteosynthesis (MIPO) with an Enhanced Recovery after Surgery (ERAS) protocol yields better outcomes for proximal humeral fractures than MIPO alone. Wider adoption of ERAS-enhanced MIPO can optimize perioperative care and support longer-term function in PHF patients.