A 78-year-old woman with Garden type III intracapsular femoral neck fracture is admitted within 6 hours of injury. She is independently ambulatory and has mild hypertension controlled on amlodipine. What is the MOST appropriate definitive management?
- A Cemented hemiarthroplasty (unipolar or bipolar) ✓
- B Cannulated screw fixation in situ
- C Total hip replacement (THR)
- D Dynamic hip screw (DHS) fixation
Explanation
For displaced intracapsular femoral neck fractures (Garden III/IV) in patients over 70 with moderate functional demand and one comorbidity, cemented hemiarthroplasty is the standard of care. It eliminates risk of avascular necrosis and non-union that plague internal fixation in the elderly. THR is preferred for physiologically younger, high-demand patients with pre-existing acetabular disease. DHS and cannulated screws are reserved for undisplaced (Garden I/II) fractures or selected younger patients. Cementing is preferred over uncemented to reduce peri-prosthetic fracture risk in osteoporotic bone.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.