A 78-year-old woman sustains a Garden grade III displaced intracapsular femoral neck fracture. She was independently ambulatory before the injury. The most appropriate surgical management, accounting for the disrupted blood supply to the femoral head, is:
- A Cannulated screw fixation — preserves femoral head in elderly
- B Conservative management with skin traction for 6 weeks
- C Total hip replacement (cemented) — indicated because displaced intracapsular fracture in an independent elderly patient has very high AVN and failure rates with fixation ✓
- D Unipolar hemiarthroplasty — this is always preferred over THR in the elderly
Explanation
Displaced intracapsular femoral neck fractures (Garden III/IV) in independently ambulatory elderly patients have AVN rates of 20–30% and non-union rates of 30% with fixation due to disruption of the circumflex femoral artery blood supply to the femoral head. Current evidence (HEALTH trial data and NICE guidelines) favours total hip replacement over hemiarthroplasty in fit, independently active elderly patients as THR provides significantly better functional outcomes, lower revision rates, and reduced pain at mid-term follow-up, albeit with slightly higher early dislocation risk. Hemiarthroplasty is preferred in cognitively impaired or institutionalised patients with limited activity demands. Conservative management in displaced fractures leads to unacceptable pain and non-union.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.