A 72-year-old woman presents with a displaced subcapital fracture of the femoral neck (Garden IV). She is otherwise medically fit. The preferred surgical management is:

• A Hemiarthroplasty or total hip replacement rather than internal fixation ✓
• B Conservative management with skin traction for 6 weeks
• C Cannulated screw fixation to preserve the femoral head
• D Dynamic hip screw fixation

Explanation

In elderly patients (>65 years) with displaced subcapital femoral neck fractures (Garden III and IV), the risk of avascular necrosis of the femoral head and non-union following internal fixation exceeds 30%. Arthroplasty (hemiarthroplasty for low-demand patients, total hip replacement for active patients with pre-existing acetabular disease) provides immediate weight-bearing and avoids the risk of fixation failure. Internal fixation is preferred only in young (<60 years) patients where head preservation is a priority despite the risk.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.