A 78-year-old osteoporotic woman sustains a displaced subcapital femoral fracture (Garden IV). The optimal surgical management to minimize morbidity and allow immediate full weight bearing is:
- A Closed reduction and percutaneous cannulated screw fixation
- B Dynamic hip screw fixation
- C Hemiarthroplasty (cemented) ✓
- D Total hip replacement
Explanation
In elderly patients (>65–70 years) with displaced subcapital femoral neck fractures (Garden III/IV), the risk of avascular necrosis and fixation failure with internal fixation is very high (30–50%). Hemiarthroplasty (unipolar or bipolar, cemented) is preferred as it allows immediate full weight bearing, avoids reoperation for failed fixation, and provides reliable pain relief. Cemented stems reduce intraoperative fracture risk and provide immediate stability in osteoporotic bone. Total hip replacement is an option for higher-demand patients with pre-existing acetabular arthritis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.