Arthroplasty — MCQs

Question 31: The treatment of choice for a 65-year-old man who presented with a fracture of the neck of femur three days after injury is:

• A. Multiple screw fixation
• B. Mc-Murray osteotomy
• C. Total hip replacement
• D. Hemiarthroplasty (Correct Answer)

Explanation: ***Hemiarthroplasty*** - For a 65-year-old patient with a **femoral neck fracture** recognized three days post-injury, **hemiarthroplasty** is the treatment of choice due to the high risk of **avascular necrosis** (AVN) of the femoral head and non-union. - The delay in presentation increases the likelihood of compromised blood supply to the femoral head, making internal fixation less reliable. *Multiple screw fixation* - This method is typically preferred for **younger patients** (under 60-65 years) with femoral neck fractures where the blood supply to the femoral head is still largely preserved. - The three-day delay and the patient's age in this case significantly increase the risk of **femoral head avascular necrosis**, making internal fixation unsuitable. *Mc-Murray osteotomy* - **McMurray osteotomy** is an older procedure primarily used for treating **osteoarthritis of the hip** or non-union of femoral neck fractures in active individuals, rather than as an acute treatment for a fresh fracture. - It involves reshaping the bone to shift weight-bearing forces and is not indicated for the immediate management of a femoral neck fracture in a 65-year-old. *Total hip replacement* - While a **total hip replacement** (THR) is an excellent option for older, more active patients with femoral neck fractures or severe osteoarthritis, it is generally considered a more extensive surgery with a higher risk of complications compared to hemiarthroplasty for this patient profile. - **Hemiarthroplasty** is often favored for elderly patients with lower functional demands and higher morbidity risks, as it offers quicker recovery and less operative time, addressing the acute fracture effectively.