A 75-year-old woman on anticoagulants sustains a Garden Type IV subcapital femoral neck fracture. She was independently mobile before injury with no significant comorbidities. The optimal surgical treatment is:
- A Dynamic hip screw (DHS) fixation
- B Total hip arthroplasty (THA) ✓
- C Cannulated screw fixation (3 screws)
- D Hemiarthroplasty (unipolar or bipolar)
Explanation
Garden Type IV is a completely displaced subcapital femoral neck fracture with 100% interruption of the precarious blood supply to the femoral head, making avascular necrosis inevitable with internal fixation (rate >50% for displaced fractures). For an independently mobile, medically fit elderly patient, total hip arthroplasty (THA) gives superior functional outcomes and lower revision rates compared to hemiarthroplasty, and avoids acetabular erosion (protrusio) seen with unipolar hemiarthroplasty over time. Hemiarthroplasty is preferred in less active, cognitively impaired, or institutionalized patients. NICE and international guidelines now support THA over hemiarthroplasty for fit, ambulant patients with displaced subcapital fractures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.