An 80-year-old woman with displaced femoral neck fracture (Garden Type IV) is evaluated for surgery. Which surgical option is MOST appropriate according to current NICE/AO guidelines?
- A Cannulated cancellous screws
- B Dynamic hip screw
- C Total hip replacement if community-ambulatory ✓
- D Hemiarthroplasty (cemented)
Explanation
Current guidelines (NICE CG124, BOA BOAST) recommend total hip replacement (THR) over hemiarthroplasty for displaced intracapsular femoral neck fractures in patients who are medically fit, independently mobile, and not cognitively impaired — as THR has better functional outcomes and lower revision rates at 3-5 years. Hemiarthroplasty (cemented) is appropriate for patients with limited mobility or cognitive impairment. Cannulated screws and DHS are options for undisplaced (Garden I/II) fractures or young patients where head salvage is attempted. For an 80-year-old who is community-ambulatory, THR is the current preferred standard.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.