QuestionSBA
QuestionChoice
This is not appropriate; the patient has an intracapsular fracture. Dynamic hip screws are used in cases of intertrochanteric fractures. This patient requires a total hip replacement.
10034910
d
Dynamic hip screw
QuestionChoice
This is not appropriate; intramedullary nails are used for subtrochanteric fractures, to fix the femoral shaft. This patient requires a total hip replacement.
10034909
c
Intramedullary nail
QuestionChoice
ORIF can be considered for patients with minimally displaced (i.e. Garden I/II) fractures. This option is generally considered in younger patients, as it minimises the risk of a re-operation due to failure of a prosthetic. This patient may have been a candidate for an ORIF if their fracture was less displaced, however it has been classified Garden IV. They require a total hip replacement.
10034911
e
Open reduction, internal fixation (ORIF)
QuestionChoice
This would be an appropriate course of treatment if the patient was older, frailer, or had poor baseline mobility. This is because while a hemiarthroplasty is less complex than a total hip replacement, the improvement in quality of life provided is not as good, and the rates of revision operations are higher.
10034908
b
Hemiarthroplasty
QuestionChoice
This is the most appropriate course of management of the options provided, as the patient has good mobility at baseline and has an intracapsular fracture. A total hip replacement is more appropriate given the patient is relatively young, as this procedure has been shown to provide patients with a better quality of life and a lower rate of needing a revision operation.
10034907
a
Total hip replacement
Concept
Chapter
2693
6102
Fractured neck of femur
Topic
331
Orhtopaedics
19385
In patients with intracapsular neck of femur fractures and good pre-injury mobility, total hip replacement is often the preferred management option.
A 66-year-old woman is admitted to hospital after suffering a fall at home. She has severe pain around the left hip region and says she cannot move her leg.

On examination, her left leg is shortened and externally rotated. A pelvic X-ray shows a Garden IV intracapsular neck of femur fracture.

The patient has no significant past medical history and reports being completely independent with all activities of daily living, without the need for any walking aids.

What is the most appropriate course of management?
a