Background: Among commonly used approaches, posterior approach (Moore’s) results in better regain of function as it require less muscle dissection, while the lateral approach (Hardinge’s) has a lower risk of dislocation. Objectives: To compare the functional outcome between lateral and posterior approaches for hemiarthroplasty. Methods: This parallel design randomised controlled trial of equivalence (allocation ratio 1:1) was conducted in the department of orthopaedics, BP Koirala Institute of Health Sciences with institutional ethical clearance. Fifty eligible patients of >60 years with isolated traumatic displaced neck of femur fracture, presenting during study period from September 2017 to August 2019, were conveniently recruited and randomly allocated by using computerised Excel random number generation technique to undergo hemi-replacement arthroplasty either by lateral approach (N = 25) or by posterior approach (N = 25) and were evaluated at six weeks, three months, six months, and twelve months. Final statistical analysis was done using SPSS v.20 software among 45 patients because four deceased and one was lost to follow-up. The p-value <0.05 was considered statistically significant. Results: The functional outcome as measured by the Modified Harris Hip score at one year was 83.78 ± 5.89 for lateral approach and 80.40 ± 7.56 for posterior approach group (p = 0.102). The hip pain, mean blood loss, operative time, and prothesis size was similar between the two approaches. Conclusion: The study showed that there was no significant difference between the two approaches for hemireplacement arthroplasty in terms of mean operating time, hip pain, and functional outcomes.

Subungual exostosis is typically a rare benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux of toes or fingers. These are usually associated with secondary changes such as elevation of the nail plate, ulceration or subungual hyperkeratosis and hyperpigmentation. On histological examination, the lesion consists of mature bone at the base with proliferating fibrocartilaginous cap. A 14-year-old male presented with a solitary firm swelling gradually increasing in size for three months on the distal part of the right great toe. On physical examination, a firm, non-tender, non-mobile, whitish nodule was noted in the distal dorsomedial aspect of the right great toe distorting the adjacent nail. Radiographs demonstrated a dorsal bony outgrowth that was continuous with the distal phalanx. Excisional biopsy was done and on histopathological examination, a characteristic trabecular pattern of mature bone covered with a hyaline and fibrocartilaginous cap was seen. There was lack of true anaplasia, thereby confirming the diagnosis of subungual exostosis. There was no recurrence over six months. This topic is underrepresented in the orthopaedic literature, because many of the important clinical series have been published in journals from other branches of medicine i.e. mainly by dermatologists and pathologists. This reflects the fact that the condition is treated by many kinds of non-orthopaedic providers. We, as orthopaedic surgeons, must be careful while evaluating lesions of distal phalanges, always keeping in mind the possibility of subungual exostosis. Radiographs are helpful in diagnosis but confirmation can be done by histopathological examination. En bloc excision with minimal nail plate deformation can help prevent recurrence or deformity.