A 70-year-old woman presents with a Garden Grade III displaced subcapital femoral neck fracture 12 hours after a fall. She is independently ambulatory and has no cognitive impairment. The most appropriate surgical treatment is:
- A Cannulated screw fixation (3 screws) to preserve the femoral head
- B Total hip replacement (THR) for an active, cognitively intact elderly patient ✓
- C Hemiarthroplasty (Austin Moore or cemented Thompson) as the only option for all elderly patients
- D Conservative management with traction given her age
Explanation
For displaced femoral neck fractures (Garden III/IV) in active, cognitively intact elderly patients (physiological age >60 years), total hip replacement (THR) is preferred over hemiarthroplasty because it provides significantly better functional outcomes, higher activity levels, and lower rates of acetabular erosion and groin pain at 5-10 year follow-up. Hemiarthroplasty (cemented) is preferred in frail, less active, or cognitively impaired patients due to shorter surgical time and adequate results for their functional demands. In patients <65 years (young physiological age), reduction and internal fixation to preserve the femoral head is attempted. Cannulated screws in a displaced fracture in a 70-year-old have unacceptably high rates of AVN and revision.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.