A 75-year-old woman sustains an intracapsular femoral neck fracture (Garden type III). She has mild cognitive impairment but was independently mobile with a walking stick. What is the most appropriate surgical treatment?

• A Cannulated screw fixation to preserve the femoral head
• B Hemiarthroplasty (cemented unipolar or bipolar) ✓
• C Dynamic hip screw fixation
• D Total hip replacement

Explanation

For displaced intracapsular femoral neck fractures (Garden III and IV) in elderly patients, hemiarthroplasty (replacing only the femoral head and neck) is preferred over internal fixation because the risk of avascular necrosis and non-union with fixation in displaced fractures exceeds 30–40%. Hemiarthroplasty provides immediate stable fixation allowing early weight-bearing. Total hip arthroplasty is reserved for younger, highly active patients or those with pre-existing acetabular disease. In patients with cognitive impairment, the dislocation risk of THR's posterior approach is a relative contraindication.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.