Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I² = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p < 0.00001) and a significantly lower rate of reoperation (I² = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making.

Background: Carpal tunnel release (CTR) surgery may have an impact on the speed and accuracy of handwriting and digital typing using a computer or mobile devices. Methods: In this prospective cohort study, patients undergoing CTR surgery of the dominant hand, between 18 and 70 years of age, with frequent use of a QWERTY keyboard and smartphone were included. A baseline Visual Analog Scale (VAS) for subjective alteration of writing and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were collected at a maximum 3-month follow-up. Digital typing speed (word per minute, wpm) and accuracy (number of mistakes) were tested. Handwriting was assessed by means of direct supervision of one investigator. Results: Of the 30 enrolled patients, 23 (76.7%) completed the 3-month follow-up and were included in the final analysis (mean age 55 ± 12.3 years). Pre- and post-surgery improvements in keyboard typing speed (14.8 ± 6.8 wpm to 17.6 ± 5 wpm) and mobile texting speed (16.7 ± 5.9 wpm to 21.7 ± 6.5 wpm) were significantly improved over time. Accuracy improved significantly only in keyboard typing, where the mean number of errors was reduced (13.1 ± 8.2 to 9.9 ± 5.6). QuickDASH scores decreased significantly (39.1 ± 9.1 to 17 ± 6). Conclusions: CTR surgery was associated with improved typing speed and reduced the number of errors (19% and −24%, respectively) as well as texting speed (30%). This improvement may be relevant in daily and occupational activities, as reported in the previous literature.