A 78-year-old woman with a displaced femoral neck fracture (Garden III) is medically fit for surgery. Her pre-injury mobility was limited to indoors with a frame and she has moderate dementia. The most appropriate surgical procedure is:

• A Cannulated screw fixation to preserve the native femoral head
• B Total hip replacement (THR)
• C Cemented hemiarthroplasty (bipolar or unipolar) ✓
• D Conservative management with traction and early mobilisation

Explanation

In displaced femoral neck fractures, choice between hemiarthroplasty and THR is based on pre-injury mobility and cognitive function. Cemented hemiarthroplasty is preferred for low-demand, elderly (> 75 years) patients with limited pre-injury mobility or cognitive impairment — it provides faster surgery, less blood loss, and avoids dislocation risk of THR in patients unable to comply with hip precautions. THR is preferred for younger, high-demand, cognitively intact patients. Screw fixation carries high non-union/AVN risk in displaced fractures in the elderly.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.