Orthopaedics & MSK — MCQs
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A 68-year-old man presents to his GP with a 5-month history of progressively worsening lower back pain. He describes difficulty fastening his shoes due to back stiffness, particularly in the mornings. On examination, there is reduced lumbar spine flexion with a positive Schober's test (less than 5cm expansion). What is the most appropriate initial investigation to establish the diagnosis?
A 74-year-old woman presents to the Emergency Department following a mechanical fall. Radiographs demonstrate a subcapital neck of femur fracture with complete displacement and rotation of the femoral head. The fracture fragments are not aligned and there is no bony contact between them. According to the Garden classification system, what grade is this fracture?
A 56-year-old man presents with a 3-month history of lower back pain and progressive bilateral leg weakness. Examination reveals brisk knee reflexes, upgoing plantar responses bilaterally, and sensory level at T10. MRI shows cord compression at T8 level. What is the most likely diagnosis?
A 68-year-old man with Paget's disease of bone sustains a subtrochanteric femur fracture following a minor fall. What is the most appropriate surgical management for this fracture?
A 44-year-old woman presents with chronic lower back pain. MRI lumbar spine shows a high-intensity zone (HIZ) in the posterior annulus fibrosus of the L4/L5 intervertebral disc. What does a high-intensity zone on T2-weighted MRI sequences most likely represent?
An 82-year-old woman with advanced dementia (Abbreviated Mental Test Score 3/10) and complete functional dependence sustains a displaced intracapsular neck of femur fracture. Pre-injury, she was bed-bound, doubly incontinent, and residing in a nursing home. What is the most appropriate management strategy?
A 55-year-old woman presents with a 4-month history of lower back pain, morning stiffness lasting 90 minutes, and night pain that improves with activity. She has bilateral buttock pain alternating sides. Examination reveals reduced lumbar flexion with a positive Schober's test. ESR is 42 mm/hr. Radiographs show bilateral sacroiliitis. What is the most appropriate initial pharmacological management?
A 71-year-old man undergoes dynamic hip screw fixation for an intertrochanteric neck of femur fracture. Post-operatively, the tip-apex distance (TAD) is measured on radiographs. What measurement of TAD is associated with the highest risk of cut-out of the lag screw?
A 48-year-old woman with metastatic renal cell carcinoma presents with a 3-week history of severe lower back pain that is constant, worse at night, and not relieved by lying down. Plain radiographs show a lytic lesion in the L3 vertebral body with cortical destruction and >50% vertebral body involvement. What is the most appropriate next step in management?
A 72-year-old man with an undisplaced Garden I intracapsular neck of femur fracture undergoes internal fixation with cannulated screws. What is the primary rationale for performing internal fixation rather than arthroplasty in this patient?
Orthopaedics & MSK UK Medical PG Practice Questions and MCQs
Question 141: A 68-year-old man presents to his GP with a 5-month history of progressively worsening lower back pain. He describes difficulty fastening his shoes due to back stiffness, particularly in the mornings. On examination, there is reduced lumbar spine flexion with a positive Schober's test (less than 5cm expansion). What is the most appropriate initial investigation to establish the diagnosis?
- A. Lumbar spine MRI
- B. Anteroposterior pelvis radiograph (Correct Answer)
- C. HLA-B27 antigen testing
- D. Erythrocyte sedimentation rate and C-reactive protein
- E. Bone mineral density DEXA scan
Explanation: ***Anteroposterior pelvis radiograph***- The patient's clinical presentation of **worsening lower back pain**, **morning stiffness**, reduced lumbar flexion, and a **positive Schober's test** strongly suggests **Ankylosing Spondylitis**, necessitating investigation of the sacroiliac joints.- An anteroposterior pelvis radiograph is the most appropriate **initial imaging investigation** to detect **sacroiliitis**, which manifests as erosions, sclerosis, or joint space narrowing. *Lumbar spine MRI*- While MRI is highly sensitive for detecting **early inflammatory changes** like bone marrow edema in sacroiliac joints, it is often reserved for cases where plain radiographs are inconclusive or for assessing disease activity.- MRI is not typically the **first-line investigation** to establish a diagnosis of Ankylosing Spondylitis when clinical signs are clear and conventional radiography is available.*HLA-B27 antigen testing*- Although approximately 90% of patients with Ankylosing Spondylitis are **HLA-B27 positive**, this genetic marker is not diagnostic on its own as it can be found in a significant portion of the healthy population.- It serves as a **supportive factor** rather than the initial diagnostic test to confirm clinical sacroiliitis.*Erythrocyte sedimentation rate and C-reactive protein*- **ESR and CRP** are non-specific inflammatory markers that can be elevated in active Ankylosing Spondylitis, but they are normal in up to 50% of patients.- These tests are more useful for monitoring disease activity or ruling out other inflammatory conditions, not for the **initial definitive diagnosis**.*Bone mineral density DEXA scan*- A DEXA scan is used to assess **bone mineral density** and diagnose conditions like **osteoporosis**, which can be a complication of chronic Ankylosing Spondylitis due to chronic inflammation and reduced mobility.- It has no role in the **initial diagnosis** of the inflammatory condition itself, which primarily involves the sacroiliac joints and spine.
Question 142: A 74-year-old woman presents to the Emergency Department following a mechanical fall. Radiographs demonstrate a subcapital neck of femur fracture with complete displacement and rotation of the femoral head. The fracture fragments are not aligned and there is no bony contact between them. According to the Garden classification system, what grade is this fracture?
- A. Garden I - incomplete fracture with impaction in valgus position
- B. Garden II - complete fracture without displacement
- C. Garden III - complete fracture with partial displacement
- D. Garden IV - complete fracture with complete displacement (Correct Answer)
- E. Garden V - comminuted fracture with segmental fragments
Explanation: ***Garden IV - complete fracture with complete displacement*** - This grade is characterized by a **complete fracture** with **total displacement** and often **rotation** of the femoral head, leading to a complete loss of bony contact between fragments. - Radiographically, the **trabeculae** of the femoral head are no longer aligned with those of the acetabulum, indicating a high risk of **avascular necrosis**. *Garden I - incomplete fracture with impaction in valgus position* - Represents an **incomplete** or **impacted** fracture where the trabeculae are angulated in a **valgus** position. - These are considered **undisplaced fractures** with a better prognosis and lower risk of blood supply disruption. *Garden II - complete fracture without displacement* - This is a **complete fracture** across the femoral neck, but the fragments remain in their **anatomical position**. - The **trabecular lines** across the fracture site remain **aligned** and uninterrupted on radiographs. *Garden III - complete fracture with partial displacement* - Describes a complete fracture with **partial displacement** where some degree of **bony contact** still exists between the two fragments. - The femoral head usually tilts into a **varus position**, causing the trabeculae to become **misaligned**. *Garden V - comminuted fracture with segmental fragments* - The Garden classification system only includes **four grades**, ranging from incomplete to completely displaced fractures. - There is **no Garden V** in the standard classification for intracapsular neck of femur fractures.
Question 143: A 56-year-old man presents with a 3-month history of lower back pain and progressive bilateral leg weakness. Examination reveals brisk knee reflexes, upgoing plantar responses bilaterally, and sensory level at T10. MRI shows cord compression at T8 level. What is the most likely diagnosis?
- A. Lumbar spinal stenosis with cauda equina compression
- B. Thoracic disc herniation with spinal cord compression (Correct Answer)
- C. Peripheral neuropathy with concurrent lumbar radiculopathy
- D. Multiple sclerosis with transverse myelitis
- E. Motor neuron disease with upper and lower motor neuron signs
Explanation: ***Thoracic disc herniation with spinal cord compression*** - The presence of **upper motor neuron (UMN) signs**, such as **brisk knee reflexes** and **upgoing plantar responses**, directly points to spinal cord involvement. - A **sensory level at T10** combined with MRI findings of **cord compression at T8 level** definitively localizes the lesion to the thoracic spinal cord, which is consistent with thoracic disc herniation. *Lumbar spinal stenosis with cauda equina compression* - **Cauda equina compression** affects **lower motor neurons (LMNs)**, presenting with **flaccid weakness**, **diminished or absent reflexes**, and **downgoing plantar responses**, contrasting with the UMN signs seen here. - A **sensory level at T10** and a T8 cord compression on MRI are inconsistent with a purely lumbar cauda equina pathology. *Peripheral neuropathy with concurrent lumbar radiculopathy* - Both **peripheral neuropathy** and **radiculopathy** are **lower motor neuron (LMN) disorders**, which typically cause **reduced or absent reflexes** and do not explain the **brisk reflexes** or **upgoing plantar responses**. - Neither condition would account for a clear **thoracic sensory level** or the specific MRI finding of **spinal cord compression at T8**. *Multiple sclerosis with transverse myelitis* - While **transverse myelitis** can cause UMN signs and a sensory level, the MRI in this case specifically demonstrates **extrinsic cord compression** rather than the demyelinating plaques characteristic of **Multiple Sclerosis**. - The localized back pain and MRI findings strongly suggest a **structural compressive etiology** over an inflammatory demyelinating process. *Motor neuron disease with upper and lower motor neuron signs* - **Motor neuron disease (MND)** is primarily a **motor disorder** and classically does not involve **sensory loss**, which is clearly present with a **sensory level at T10** in this patient. - MND does not cause a **structural compressive lesion** on MRI; the finding of **cord compression at T8** rules out MND as the direct cause of these symptoms.
Question 144: A 68-year-old man with Paget's disease of bone sustains a subtrochanteric femur fracture following a minor fall. What is the most appropriate surgical management for this fracture?
- A. Dynamic hip screw fixation
- B. Hemiarthroplasty
- C. Intramedullary nail fixation (Correct Answer)
- D. External fixation as definitive management
- E. Total hip replacement
Explanation: ***Intramedullary nail fixation*** - **Intramedullary nail fixation** (specifically cephalomedullary) is the gold standard for **subtrochanteric fractures** as it provides robust **load-sharing** and biomechanical stability against high deforming forces. - In **Paget's disease**, the abnormal bone structure and potential **femoral bowing** are best managed with long intramedullary devices that span the bone and reduce the risk of secondary fractures. *Dynamic hip screw fixation* - **Dynamic hip screws** (DHS) are poorly suited for subtrochanteric fractures due to the high **tensile stresses** on the lateral cortex, which often lead to hardware failure or non-union. - This extramedullary device does not offer the same mechanical advantage as a nail in the presence of **disorganized remodeling** characteristic of Pagetoid bone. *Hemiarthroplasty* - **Hemiarthroplasty** is indicated for **intracapsular femoral neck fractures** in elderly patients, not for fractures occurring distal to the lesser trochanter. - It does not address a **subtrochanteric fracture** which is located within the femoral shaft and requires stabilization rather than joint replacement. *External fixation as definitive management* - **External fixation** is typically reserved for **damage control orthopaedics** in polytrauma patients or severe open fractures, not as a primary treatment for pathological fractures. - It provides inferior stability for long-term healing and carries a high risk of **pin-site infection** and non-union in structurally weak Pagetoid bone. *Total hip replacement* - **Total hip replacement** is unsuitable for a primary fracture located 5 cm distal to the lesser trochanter as it does not stabilize the **subtrochanteric segment**. - While Paget's patients may eventually need THR for **secondary osteoarthritis**, it is not the indicated management for an acute subtrochanteric shaft fracture.
Question 145: A 44-year-old woman presents with chronic lower back pain. MRI lumbar spine shows a high-intensity zone (HIZ) in the posterior annulus fibrosus of the L4/L5 intervertebral disc. What does a high-intensity zone on T2-weighted MRI sequences most likely represent?
- A. Normal appearance of well-hydrated nucleus pulposus
- B. Annular tear with granulation tissue or fluid accumulation (Correct Answer)
- C. Sequestrated disc fragment with epidural extension
- D. Calcification within a degenerated intervertebral disc
- E. Vertebral endplate oedema (Modic type I change)
Explanation: ***Annular tear with granulation tissue or fluid accumulation***- A **high-intensity zone (HIZ)** on T2-weighted MRI, particularly in the **posterior annulus fibrosus**, is a classic sign of a **radial annular tear**.- This hyperintensity represents an accumulation of **vascularized granulation tissue**, inflammatory exudates, or fluid within the tear, which can be a source of **discogenic pain**.*Normal appearance of well-hydrated nucleus pulposus*- While the **nucleus pulposus** is normally bright (high intensity) on T2-weighted MRI due to its high water content, an **HIZ** is a distinct pathology within the **annulus fibrosus**.- The annulus fibrosus is typically dark on T2, so a focal bright signal within it is abnormal, unlike the uniformly bright central nucleus.*Sequestrated disc fragment with epidural extension*- A **sequestrated disc fragment** involves disc material that has extruded, detached from the parent disc, and moved into the **epidural space**.- An **HIZ** is an intramural finding confined within the substance of the **annulus fibrosus** itself and does not represent a free fragment in the epidural space.*Calcification within a degenerated intervertebral disc*- **Calcification** within any tissue, including the intervertebral disc, typically appears as a **low signal intensity** (dark) on both T1 and T2-weighted MRI sequences.- The term "high-intensity zone" describes a bright signal, which is the opposite of what would be seen with **calcification**.*Vertebral endplate oedema (Modic type I change)*- **Modic Type I changes** refer to **inflammatory oedema** and vascularization of the **vertebral bone marrow** adjacent to the endplates, appearing bright on T2-weighted images.- An **HIZ** is a specific finding within the **annulus fibrosus** of the intervertebral disc, not within the vertebral bone marrow.
Question 146: An 82-year-old woman with advanced dementia (Abbreviated Mental Test Score 3/10) and complete functional dependence sustains a displaced intracapsular neck of femur fracture. Pre-injury, she was bed-bound, doubly incontinent, and residing in a nursing home. What is the most appropriate management strategy?
- A. Total hip replacement to provide best functional outcome
- B. Internal fixation with cannulated screws to preserve native anatomy
- C. Cemented hemiarthroplasty under general anaesthesia
- D. Non-operative management with analgesia and palliative care approach (Correct Answer)
- E. Delay surgery until medical optimization achieves ASA grade 2
Explanation: ***Non-operative management with analgesia and palliative care approach*** - In patients who were **pre-injury bed-bound** with **advanced dementia** and complete functional dependence, the goal of care shifts from mobilization to **palliative comfort** and dignity. - The risks of surgery and anesthesia in such a frail patient often outweigh the benefits, making a **multidisciplinary approach** to pain relief and nursing care the most appropriate choice. *Total hip replacement to provide best functional outcome* - **Total hip replacement (THR)** is indicated for patients who are **cognitively intact** and able to walk independently pre-injury to achieve better long-term outcomes. - This patient’s **AMTS of 3/10** and pre-injury bed-bound status make her an unsuitable candidate for such an invasive and rehabilitative procedure. *Internal fixation with cannulated screws to preserve native anatomy* - **Internal fixation** is generally reserved for **undisplaced fractures** or younger patients where the preservation of the femoral head is a priority. - In **displaced intracapsular fractures** in the elderly, fixation carries a high risk of **avascular necrosis (AVN)** and re-operation, making it inappropriate here. *Cemented hemiarthroplasty under general anaesthesia* - While **cemented hemiarthroplasty** is the standard surgical treatment for displaced fractures in elderly patients with limited mobility, it is intended to facilitate **early weight-bearing**. - Since the patient was already **non-ambulatory**, the physiological stress of surgery provides no functional benefit while increasing the risk of perioperative mortality. *Delay surgery until medical optimization achieves ASA grade 2* - Delaying surgery for specialized optimization is often futile in patients with **severe frailty** and advanced dementia where the **ASA grade** is unlikely to significantly improve. - Guidelines emphasize that patients requiring surgery should ideally be operated on within **36 hours**, but if surgery is not in the patient's **best interest**, delay for optimization is irrelevant.
Question 147: A 55-year-old woman presents with a 4-month history of lower back pain, morning stiffness lasting 90 minutes, and night pain that improves with activity. She has bilateral buttock pain alternating sides. Examination reveals reduced lumbar flexion with a positive Schober's test. ESR is 42 mm/hr. Radiographs show bilateral sacroiliitis. What is the most appropriate initial pharmacological management?
- A. Commence methotrexate as first-line disease-modifying therapy
- B. Prescribe high-dose NSAIDs (such as naproxen) as first-line treatment (Correct Answer)
- C. Commence tumour necrosis factor-alpha (TNF-α) inhibitor therapy
- D. Prescribe oral prednisolone 40 mg daily with gradual taper
- E. Commence sulfasalazine as first-line disease-modifying agent
Explanation: ***Prescribe high-dose NSAIDs (such as naproxen) as first-line treatment*** - **NSAIDs** are the gold standard first-line treatment for **axial spondyloarthropathy**, providing both rapid symptomatic relief and potentially slowing radiographic progression. - Guidelines recommend utilizing at least two different NSAIDs at **maximum tolerated doses** for a minimum of 2-4 weeks each before considering biological therapies. *Commence methotrexate as first-line disease-modifying therapy* - **Methotrexate** has no proven efficacy in treating the **axial (spinal)** manifestations of ankylosing spondylitis. - It is primarily reserved for patients with **peripheral joint involvement**, which is not the primary presentation in this case. *Commence tumour necrosis factor-alpha (TNF-α) inhibitor therapy* - **TNF-α inhibitors** (such as adalimumab) are second-line agents indicated only after the failure or intolerance of at least two different **NSAIDs**. - While highly effective, they are not initiated first-line due to cost, potential **immunosuppressive side effects**, and strict eligibility criteria. *Prescribe oral prednisolone 40 mg daily with gradual taper* - **Systemic corticosteroids** like prednisolone are generally ineffective for long-term management of **axial symptoms** in spondyloarthropathy. - Chronic use is avoided due to the high risk of **side effects** and lack of evidence for modifying the disease course in the spine. *Commence sulfasalazine as first-line disease-modifying agent* - **Sulfasalazine** is a conventional synthetic DMARD that, like methotrexate, is only effective for **peripheral arthritis**. - It shows no clinical benefit for the **axial disease** (sacroiliitis and spondylitis) described in this patient's clinical and radiographic presentation.
Question 148: A 71-year-old man undergoes dynamic hip screw fixation for an intertrochanteric neck of femur fracture. Post-operatively, the tip-apex distance (TAD) is measured on radiographs. What measurement of TAD is associated with the highest risk of cut-out of the lag screw?
- A. 20-25 mm
- B. Less than 15 mm
- C. 15-20 mm
- D. Greater than 25 mm (Correct Answer)
- E. Greater than 30 mm
Explanation: ***Greater than 25 mm*** - A **Tip-Apex Distance (TAD)** greater than **25 mm** indicates that the lag screw is poorly positioned within the **femoral head**, increasing the leverage forces on the screw. - This suboptimal placement, specifically being too far from the **subchondral bone**, significantly elevates the risk of **mechanical failure** and **lag screw cut-out** from the femoral head. *Less than 15 mm* - A TAD of **less than 15 mm** typically signifies a deeply placed screw, which provides good purchase in the bone but can increase the risk of **joint penetration** or **avascular necrosis** of the femoral head. - This measurement is generally considered to be in a favorable zone for preventing cut-out, as the screw has **maximal stability** within the bone. *15-20 mm* - This range for TAD is widely accepted as the **ideal placement zone** for a lag screw in dynamic hip screw (DHS) fixation. - It optimizes **mechanical stability** by providing sufficient bone purchase while minimizing the risk of both cut-out and articular surface penetration. *20-25 mm* - While closer to the upper limit, a TAD within the **20-25 mm** range is still generally considered **acceptable** in many orthopedic practices. - The risk of cut-out begins to increase in this zone but becomes significantly higher and clinically concerning once the measurement **exceeds 25 mm**. *Greater than 30 mm* - Although a TAD **greater than 30 mm** certainly represents a very high risk for cut-out, the established **critical threshold** where the risk significantly escalates is traditionally defined as **greater than 25 mm**. - This option is still incorrect because **greater than 25 mm** is the *minimal* established cut-off that signifies a high risk, making it the most appropriate answer for the question's premise.
Question 149: A 48-year-old woman with metastatic renal cell carcinoma presents with a 3-week history of severe lower back pain that is constant, worse at night, and not relieved by lying down. Plain radiographs show a lytic lesion in the L3 vertebral body with cortical destruction and >50% vertebral body involvement. What is the most appropriate next step in management?
- A. Commence radiotherapy and strong analgesia with urgent orthopaedic outpatient follow-up
- B. Arrange urgent CT-guided biopsy to confirm metastatic disease
- C. Arrange urgent MRI spine and refer to spinal surgery for consideration of surgical stabilisation (Correct Answer)
- D. Prescribe high-dose NSAIDs and bisphosphonate therapy with routine oncology review
- E. Commence systemic chemotherapy and arrange elective spinal surgery if symptoms persist
Explanation: ***Arrange urgent MRI spine and refer to spinal surgery for consideration of surgical stabilisation*** - The patient's presentation with **constant, nocturnal back pain**, a known history of **metastatic renal cell carcinoma**, and **lytic lesion with >50% vertebral body involvement** indicates a high risk of **spinal instability** and impending or actual **spinal cord compression**. - An **urgent MRI spine** is crucial to assess the extent of spinal cord involvement, **thecal sac compression**, and overall stability, which will guide the need for **surgical stabilisation** to prevent neurological deficits and manage pain. *Commence radiotherapy and strong analgesia with urgent orthopaedic outpatient follow-up* - Radiotherapy is often used for metastatic spinal lesions but is **less effective for highly vascular and radioresistant tumors like renal cell carcinoma**. More importantly, it **does not address mechanical instability**, which is a primary concern here. - Outpatient follow-up is insufficient for a potentially **unstable spine** with significant vertebral body destruction, as it risks **acute neurological deterioration** while delaying definitive intervention. *Arrange urgent CT-guided biopsy to confirm metastatic disease* - The patient has a **known history of metastatic renal cell carcinoma**, and the radiographic findings of a lytic lesion are consistent with metastatic disease, making a biopsy **unnecessary and delaying critical treatment**. - The priority in this scenario is to assess and manage the **mechanical stability of the spine** and potential **spinal cord compression**, not to reconfirm the diagnosis of metastatic disease. *Prescribe high-dose NSAIDs and bisphosphonate therapy with routine oncology review* - While analgesia (NSAIDs) and bisphosphonates are part of supportive care for bone metastases, they **do not address the underlying spinal instability** or the imminent risk of **pathological fracture and neurological compromise**. - A **routine oncology review** is inadequate for a patient presenting with acute, severe, constant pain and significant vertebral destruction, which requires **urgent intervention** to prevent catastrophic outcomes. *Commence systemic chemotherapy and arrange elective spinal surgery if symptoms persist* - **Renal cell carcinoma is often resistant to conventional chemotherapy**, making this an unlikely primary effective strategy for immediate pain relief or spinal stabilization. - **Elective spinal surgery** is inappropriate for an unstable spine at high risk of collapse; intervention needs to be **urgent and proactive** to prevent irreversible neurological damage, not reactive after symptom persistence.
Question 150: A 72-year-old man with an undisplaced Garden I intracapsular neck of femur fracture undergoes internal fixation with cannulated screws. What is the primary rationale for performing internal fixation rather than arthroplasty in this patient?
- A. Internal fixation has lower risk of infection compared to arthroplasty
- B. Undisplaced fractures have intact blood supply with lower risk of avascular necrosis, preserving native anatomy (Correct Answer)
- C. Internal fixation requires shorter operative time and is safer for elderly patients
- D. Cannulated screws provide superior biomechanical stability compared to arthroplasty
- E. Internal fixation eliminates the need for post-operative anticoagulation
Explanation: ***Undisplaced fractures have intact blood supply with lower risk of avascular necrosis, preserving native anatomy*** - In **Garden I and II** fractures, the **retinacular vessels** are largely intact, significantly reducing the risk of **avascular necrosis (AVN)** compared to displaced fractures. - Internal fixation aims to **preserve the native femoral head**, which is the physiological preference when the risk of non-union or ischemia is low. *Internal fixation has lower risk of infection compared to arthroplasty* - While internal fixation is less invasive, **infection risk** is not the primary clinical factor driving the choice to avoid replacement in stable fractures. - Modern **arthroplasty** techniques have standardized infection protocols, making the biological potential for healing the more critical decision factor. *Internal fixation requires shorter operative time and is safer for elderly patients* - Although fixation is usually faster, **Garden classification**-based management focuses on **fracture biology** and blood supply rather than just surgical duration. - Standard of care for **displaced** fractures in similarly aged patients is still arthroplasty, despite the longer operative time, due to the high failure rate of fixation in those cases. *Cannulated screws provide superior biomechanical stability compared to arthroplasty* - Arthroplasty actually provides **superior immediate stability** and typically allows for **immediate full weight-bearing**, which is vital for elderly recovery. - Cannulated screws rely on **secondary bone healing** and the intrinsic stability of the impacted or non-displaced fracture pattern. *Internal fixation eliminates the need for post-operative anticoagulation* - All hip fracture surgeries, regardless of the implant used, require **post-operative thromboprophylaxis** to prevent deep vein thrombosis and pulmonary embolism. - The risk of **venous thromboembolism (VTE)** is high in hip surgery patients due to immobility and the systemic inflammatory response, regardless of the fixation method.
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