A 78-year-old woman is brought to the emergency department after falling at home. She reports immediate left hip pain and is unable to bear weight. Her medical history includes hypertension and osteoporosis. Vital signs are within normal limits. Physical examination shows the left leg is shortened and externally rotated. Radiographs reveal a displaced fracture through the femoral neck.
Which of the following is the most appropriate definitive management?
The correct answer is:
B) Hemiarthroplasty
Displaced femoral neck fractures in elderly patients disrupt the blood supply to the femoral head via the medial femoral circumflex artery, placing the patient at high risk for avascular necrosis and nonunion. Because bone healing potential is limited in older adults, hemiarthroplasty provides the best functional outcome and allows early mobilization.
Answer choice A: Closed reduction and casting, is incorrect. Casting does not provide adequate stabilization and leads to prolonged immobility and increased risk of complications such as deep vein thrombosis (DVT) and pneumonia.
Answer choice C: Nonoperative management with early mobilization, is incorrect. Nonoperative management is associated with high morbidity and mortality in displaced hip fractures.
Answer choice D: Open reduction and internal fixation, is incorrect. Open reduction and internal fixation (ORIF) is preferred in younger patients with nondisplaced fractures where femoral head preservation is feasible.
Answer choice E: Total hip arthroplasty, is incorrect. Total hip replacement may be considered in select, highly active elderly patients but is not first-line for most displaced femoral neck fractures.
Key Learning Point
Displaced femoral neck fractures in elderly patients are treated with hemiarthroplasty due to a high risk of avascular necrosis.
