A 75-year-old woman presents with a Garden type IV femoral neck fracture. She is functionally independent and walks without aids. The preferred surgical management is:
- A Total hip arthroplasty (THA) ✓
- B Internal fixation with cannulated cancellous screws
- C Cemented bipolar hemiarthroplasty
- D Skeletal traction for 6 weeks followed by rehabilitation
Explanation
In physiologically fit, active, independently ambulatory elderly patients with displaced femoral neck fractures (Garden III/IV), total hip arthroplasty (THA) provides superior functional outcomes compared to hemiarthroplasty at 2-year follow-up (HEALTH trial, 2019). THA is preferred for active patients due to lower acetabular erosion, better hip scores, and similar reoperation rates when performed by experienced surgeons. Hemiarthroplasty (cemented unipolar/bipolar) is appropriate for less active or cognitively impaired patients. Internal fixation in displaced fractures in the elderly has high failure rates (30-40%).
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.