Introduction: Total hip replacement (THR) in the neck of femur fracture in the elderly is associated with a higher risk of dislocation compared to hemiarthroplasty of hip or total hip replacement in the native hip. There is uncertainty regarding combining surgical approach, femoral head size, and the usage of single bearing or dual mobility to reduce the risk of dislocation. This study looks into the bearing of the prosthesis for posterior or lateral surgical hip approach as well as their head size to give a stable hip to these vulnerable groups of patients.Methods: Initial data were collected retrospectively from February 2017 till May 2019 from the electronic records database and clinical notes. Patients included in the study had a femoral neck fracture (age >60 years) who underwent a total hip replacement. Subsequent data were collected prospectively from June 2019 to July 2020.Results: High rate of dislocation was found with posterior approach and single bearing prosthesis. However, if dual mobility prosthesis was used while using the posterior approach the dislocation rate was very low. Also, with lateral approach and single bearing prosthesis using large femoral head size, the dislocation rate was negligible. Conclusions: We recommend a dual mobility prosthesis for posterior approach THR and lateral approach with single-bearing hip replacement with large size femoral head. The dislocation rate is low using this principle irrespective of the surgical approach.
Bennett's fracture is a relatively common fracture of the base of the thumb with no consensus on optimum management. Determining the optimal treatment method for Bennett's fractures remain a challenge and has been the subject of much debate. This systematic review aims to investigate present and past literature and determine the optimum treatment intervention for Bennett's fracture-dislocation. The primary outcome measure is post-traumatic arthritis, and the secondary outcome measures are reoperation, pain, infection, and nonunion.As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed to evaluate patient demographics, clinical profile, management, and treatment outcomes. Two authors independently performed electronic searches of the Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Cochrane databases. Studies conducted between 1963 and 2021 with articles reporting Bennett's fracture management were included. The study was registered with PROSPERO (CRD42021295464).In the initial screening, 58 articles were identified, of which 13 articles met the criteria and were included in the final review, evaluating 558 patients. Out of these, 439 were managed by various surgical procedures, and 119 were treated by manipulation and plaster of Paris (POP) immobilization. Of the 13 studies considered, eight have a clear mention of post-traumatic osteoarthritis, with a total of 50 (9%) patients. Secondary outcomes included pain in 76 (13%) patients, infection in four patients, reoperation in 11 (2%) patients, and no nonunion.This review was conducted with the help of retrospective studies as there is no randomized controlled trial on the management of Bennett's fracture. Our primary outcome measure of post-traumatic arthritis in patients being treated by operative and conservative methods was mentioned in these studies. However, due to the sample size being small and the heterogenicity of these studies, the strength of these findings is low. Due to these shortfalls, this review study cannot recommend any single (or) particular treatment for all patients with Bennett's fracture.
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