A 75-year-old woman with a displaced intracapsular femoral neck fracture (Garden type IV) is seen 12 hours after injury. She is fit for surgery (ASA II). The optimal treatment to allow immediate full weight-bearing and avoid the risk of avascular necrosis is:

• A Cannulated screw fixation (3 parallel screws)
• B Dynamic hip screw (DHS) fixation
• C Hemiarthroplasty (unipolar or bipolar)
• D Total hip replacement if the patient is medically fit and functionally active pre-injury ✓

Explanation

In elderly patients with displaced intracapsular femoral neck fractures, internal fixation risks avascular necrosis (30–40%) and fixation failure. For physiologically fit, independently ambulant patients (as this patient is — ASA II, fit for surgery), NICE and AAOS guidelines recommend total hip replacement (THR) over hemiarthroplasty because it offers superior functional outcomes, lower rates of reoperation, and better long-term pain relief. Hemiarthroplasty (C) is appropriate for less active, lower-demand elderly patients or those unsuitable for THR (limited life expectancy, cognitive impairment). Internal fixation (A/B) is reserved for non-displaced or valgus impacted (Garden I/II) fractures.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.