Question 1

Q: A 72-year-old osteoporotic woman is brought to the emergency department after a low-energy fall from standing height. Prior to the fall, she was independently mobile in the community without any walking aids, lived alone, and was cognitively intact with no history of dementia or significant cognitive impairment. She has severe right hip pain and is unable to bear weight. On examination, the right lower limb is shortened and externally rotated. Her AP pelvis radiograph confirms a displaced intracapsular (subcapital) femoral neck fracture (Garden Grade IV) as shown in Image 1. She is medically fit for surgery with no significant comorbidities. What is the most appropriate definitive surgical management?

A. Cemented total hip replacement. ***A. Cemented total hip replacement*** - Per **NICE guidelines**, patients with displaced intracapsular fractures who were **independently mobile**, cognitively intact, and medically fit should receive a **Total Hip Replacement (THR)** rather than hemiarthroplasty. - **Cementing** is preferred in elderly, **osteoporotic** patients to provide immediate stability, allow for early mobilization, and reduce the risk of periprosthetic fractures. *B. Cannulated cancellous screw fixation* - This method is typically reserved for **undisplaced intracapsular fractures** (Garden I and II) or for young patients where **head preservation** is the primary goal. - In an elderly patient with a **Garden IV (displaced)** fracture, internal fixation is associated with unacceptably high rates of **non-union** and **avascular necrosis**. *C. Dynamic hip screw with side plate* - A **Dynamic Hip Screw (DHS)** is the gold standard for **extracapsular intertrochanteric** hip fractures, not subcapital intracapsular fractures. - Using a DHS for a subcapital fracture does not address the high risk of **blood supply disruption** to the femoral head seen in displaced intracapsular patterns. *D. Skeletal traction followed by delayed internal fixation* - **Skeletal traction** is only a temporary stabilizing measure and is not considered a **definitive surgical treatment** for femoral neck fractures. - Prolonged immobility in elderly patients leads to severe complications such as **pressure sores**, **DVT/PE**, and **hypostatic pneumonia**, greatly increasing mortality.

Question

A 72-year-old osteoporotic woman is brought to the emergency department after a low-energy fall from standing height. Prior to the fall, she was independently mobile in the community without any walking aids, lived alone, and was cognitively intact with no history of dementia or significant cognitive impairment. She has severe right hip pain and is unable to bear weight. On examination, the right lower limb is shortened and externally rotated. Her AP pelvis radiograph confirms a displaced intracapsular (subcapital) femoral neck fracture (Garden Grade IV) as shown in Image 1. She is medically fit for surgery with no significant comorbidities. What is the most appropriate definitive surgical management?

Accepted Answer

A. Cemented total hip replacement

Answer

B. Cannulated cancellous screw fixation

Answer

C. Dynamic hip screw with side plate

Answer

D. Skeletal traction followed by delayed internal fixation

Trauma — MCQs

Trauma — MCQs

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