A 72-year-old woman sustains a femoral neck fracture after a low-energy fall. Garden classification shows complete displacement with 180° rotation of the femoral head relative to the neck axis. The most appropriate definitive management is:
- A Dynamic hip screw fixation
- B Cannulated cancellous screws
- C Hemiarthroplasty ✓
- D Total hip replacement (THR)
Explanation
Garden Type IV fractures (complete displacement, 180° rotation — loss of trabeculae alignment) in elderly, low-demand patients carry a very high risk of avascular necrosis (>30%) and non-union with internal fixation. Hemiarthroplasty (unipolar or bipolar) is the preferred treatment for physiologically elderly, low-demand patients, avoiding the risk of AVN and the need for revision surgery. THR is indicated for active elderly patients or those with pre-existing acetabular arthritis. Cannulated screws and dynamic hip screws are used for undisplaced or impacted fractures (Garden I/II) in younger, physiologically fit patients.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.