Orthopaedics & MSK — MCQs
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A 68-year-old man with multiple myeloma presents with a 5-week history of progressively worsening thoracic back pain. Over the past 3 days he has developed difficulty walking and leg weakness. On examination, power is 4/5 in hip flexion bilaterally, 3/5 in knee extension, and 2/5 in ankle dorsiflexion. He has a sensory level at T10. Anal tone is reduced. What is the most appropriate immediate management?
A 57-year-old man presents to the Emergency Department with a 48-hour history of severe lower back pain, bilateral leg weakness, and difficulty passing urine. He reports reduced sensation in the perineal area. On examination, power is 3/5 in both legs with absent ankle reflexes bilaterally. Post-void residual volume is 650ml. What is the time-critical management priority?
A 70-year-old man sustains an undisplaced Garden I intracapsular neck of femur fracture. He has severe osteoarthritis of the ipsilateral hip with significant pain and functional limitation pre-injury. He was mobilizing with two crutches. What is the most appropriate surgical management?
A 39-year-old woman with known ulcerative colitis presents with a 20-week history of lower back pain and stiffness. The pain is worse in the early morning with stiffness lasting 2 hours. She also reports pain and swelling in her right knee and left ankle. Examination reveals reduced lumbar spine flexion with a Schober's test of 3cm (normal >5cm). What is the most appropriate initial management?
A 76-year-old woman sustains a trochanteric neck of femur fracture with a reverse oblique pattern on radiographs. She is independently mobile with one stick. Which of the following is the most appropriate surgical fixation method?
A 64-year-old man presents with a 3-week history of progressively worsening lower back pain. He describes the pain as constant, severe, and unrelieved by rest or analgesia. He has unintentional weight loss of 8kg over 2 months and reports fever and night sweats. He emigrated from Pakistan 15 years ago. Examination reveals tenderness over L3-L4 vertebrae. Temperature is 37.9°C. What is the most likely diagnosis?
An 81-year-old woman undergoes cemented hemiarthroplasty for a displaced intracapsular neck of femur fracture. During cementation, she develops sudden hypotension (BP 75/40 mmHg), desaturation (SpO₂ 88% on room air), and reduced end-tidal CO₂. What is the immediate management priority?
A 46-year-old warehouse worker presents to his GP with a 14-week history of lower back pain. The pain is worse in the morning with stiffness lasting approximately 90 minutes. It improves with activity and is worse with rest. He has no red flag symptoms. Inflammatory markers show CRP 42 mg/L and ESR 38 mm/hr. Plain radiographs of the lumbar spine and sacroiliac joints are normal. What is the most appropriate next investigation?
A 72-year-old man sustains a Garden III intracapsular neck of femur fracture. He has a past medical history of atrial fibrillation and is anticoagulated with apixaban. His surgery is delayed by 36 hours to allow for reversal of anticoagulation. What is the primary reason this surgical delay increases his risk of complications?
A 67-year-old woman presents to the Emergency Department following a fall. She has a shortened and externally rotated leg. Radiographs confirm a displaced intracapsular neck of femur fracture. She has a history of chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) and rheumatoid arthritis treated with methotrexate. She was independently mobile pre-injury. Which of the following is the most appropriate surgical management?
Orthopaedics & MSK UK Medical PG Practice Questions and MCQs
Question 11: A 68-year-old man with multiple myeloma presents with a 5-week history of progressively worsening thoracic back pain. Over the past 3 days he has developed difficulty walking and leg weakness. On examination, power is 4/5 in hip flexion bilaterally, 3/5 in knee extension, and 2/5 in ankle dorsiflexion. He has a sensory level at T10. Anal tone is reduced. What is the most appropriate immediate management?
- A. Commence intravenous dexamethasone 16mg and arrange urgent MRI spine within 24 hours (Correct Answer)
- B. Arrange routine outpatient MRI and commence oral analgesia
- C. Immediate surgical decompression without imaging
- D. Commence radiotherapy and arrange MRI within 1 week
- E. Commence intravenous antibiotics and arrange CT-guided biopsy
Explanation: ***Commence intravenous dexamethasone 16mg and arrange urgent MRI spine within 24 hours*** - This patient presents with **Metastatic Spinal Cord Compression (MSCC)**, an oncological emergency requiring immediate **high-dose corticosteroids** to reduce peritumoral edema and preserve neurological function. - An **urgent MRI of the whole spine** is the gold standard investigation and must be performed within **24 hours** to confirm the level of compression and guide definitive management (surgery or radiotherapy). *Arrange routine outpatient MRI and commence oral analgesia* - Routine imaging is inappropriate for suspected **MSCC**, as neurological deficits can progress rapidly and become irreversible if not addressed promptly. - Delaying diagnosis and definitive treatment with an outpatient MRI would likely lead to permanent **neurological deficits** given the progressive motor weakness and reduced anal tone. *Immediate surgical decompression without imaging* - Surgical decompression should never be performed without prior imaging, as it is essential to visualize the **exact spinal level**, the extent of the **tumor mass**, and rule out multiple compression sites. - MRI is necessary to determine if the patient is a candidate for **surgical decompression** versus radiotherapy based on spinal stability, tumor location, and patient comorbidities. *Commence radiotherapy and arrange MRI within 1 week* - While **Multiple Myeloma** is a radiosensitive tumor, radiotherapy cannot be initiated until the exact compression site and extent are defined by an **urgent MRI**. - A one-week delay for imaging is far too long for a patient already experiencing **progressive motor weakness** and reduced **anal tone**, as irreversible damage can occur within hours to days. *Commence intravenous antibiotics and arrange CT-guided biopsy* - This management plan is typically reserved for suspected **spinal epidural abscess** or other infectious causes, which are less likely given the patient's known history of **multiple myeloma**. - Prioritizing a biopsy over immediate **spinal cord decompression** (via steroids and subsequent surgery/radiation) would result in avoidable and potentially permanent neurological damage.
Question 12: A 57-year-old man presents to the Emergency Department with a 48-hour history of severe lower back pain, bilateral leg weakness, and difficulty passing urine. He reports reduced sensation in the perineal area. On examination, power is 3/5 in both legs with absent ankle reflexes bilaterally. Post-void residual volume is 650ml. What is the time-critical management priority?
- A. Immediate MRI spine and urgent neurosurgical referral for decompression within 48 hours of symptom onset (Correct Answer)
- B. Commence high-dose intravenous dexamethasone and arrange elective MRI
- C. Insert urinary catheter and arrange outpatient MRI within 2 weeks
- D. Commence broad-spectrum antibiotics and arrange urgent CT spine
- E. Bed rest, analgesia, and physiotherapy review
Explanation: ***Immediate MRI spine and urgent neurosurgical referral for decompression within 48 hours of symptom onset*** - This patient presents with classic features of **Cauda Equina Syndrome (CES)**, including bilateral leg weakness, **saddle anesthesia**, and urinary retention, which is a **surgical emergency**. - An **immediate MRI** is required to confirm compression, and surgical decompression must be performed as soon as possible, ideally within **48 hours of symptom onset**, to prevent permanent neurological damage. *Commence high-dose intravenous dexamethasone and arrange elective MRI* - High-dose steroids are the priority for **Metastatic Spinal Cord Compression (MSCC)** to reduce edema, but CES is typically caused by **disc herniation** requiring mechanical decompression. - Arranging an **elective MRI** is dangerous, as delays in diagnosis and treatment of CES lead to irreversible **bladder, bowel, and sexual dysfunction**. *Insert urinary catheter and arrange outpatient MRI within 2 weeks* - While a catheter is necessary to manage **urinary retention** as a symptom, it does not address the underlying **thecal sac compression**. - An **outpatient MRI** timeframe of 2 weeks is entirely inappropriate for an acute neurological deficit; diagnosis must occur within hours, not weeks. *Commence broad-spectrum antibiotics and arrange urgent CT spine* - Antibiotics are only indicated if **spinal epidural abscess** or discitis is suspected, which is not the primary presentation here; the main management remains urgent imaging and decompression. - **CT spine** is inferior to MRI for visualizing **soft tissue pathology**, such as a massive central disc prolapse, which is the most common cause of CES. *Bed rest, analgesia, and physiotherapy review* - This conservative management approach is appropriate for simple **mechanical low back pain** but is entirely contraindicated in the presence of **red flag symptoms** like those seen in CES. - Delaying surgical intervention by recommending bed rest and physiotherapy in the setting of **motor deficits** and bladder dysfunction constitutes medical negligence and can lead to permanent disability.
Question 13: A 70-year-old man sustains an undisplaced Garden I intracapsular neck of femur fracture. He has severe osteoarthritis of the ipsilateral hip with significant pain and functional limitation pre-injury. He was mobilizing with two crutches. What is the most appropriate surgical management?
- A. Cannulated screw fixation
- B. Dynamic hip screw fixation
- C. Hemiarthroplasty
- D. Total hip replacement (Correct Answer)
- E. Conservative management with protected weight-bearing
Explanation: ***Total hip replacement***- Although Garden I fractures are typically managed with internal fixation, the presence of **pre-existing symptomatic osteoarthritis** makes total hip replacement (THR) the definitive choice to address both the fracture and the chronic joint pain.- NICE guidelines suggest **THR** as a primary option for intracapsular fractures when it provides a better long-term functional outcome, especially in patients with joint disease that would otherwise require future surgery.*Cannulated screw fixation*- This method is used for stable, **undisplaced fractures** in patients without pre-existing joint pathology, but would leave the patient with persistent **osteoarthritic pain**.- It has a risk of **avascular necrosis** or non-union, and does not address the underlying degenerative disease of the acetabulum.*Dynamic hip screw fixation*- This is the standard treatment for **extracapsular intertrochanteric fractures**, not for intracapsular neck of femur fractures.- Using a DHS in the presence of severe **hip osteoarthritis** would fail to provide functional relief for the patient's pre-injury disability.*Hemiarthroplasty*- This procedure replaces the femoral head but leaves the arthritic **acetabulum** intact, which would lead to continued pain due to the pre-existing joint surface damage.- It is generally reserved for older, less active patients with **displaced fractures** who do not have symptomatic hip osteoarthritis.*Conservative management with protected weight-bearing*- This is rarely indicated for femoral neck fractures due to the high risk of **displacement**, non-union, and complications of immobility like **venous thromboembolism**.- It would be considered only for patients who are **medically unfit** for any form of anesthesia or surgery.
Question 14: A 39-year-old woman with known ulcerative colitis presents with a 20-week history of lower back pain and stiffness. The pain is worse in the early morning with stiffness lasting 2 hours. She also reports pain and swelling in her right knee and left ankle. Examination reveals reduced lumbar spine flexion with a Schober's test of 3cm (normal >5cm). What is the most appropriate initial management?
- A. Methotrexate and physiotherapy
- B. NSAIDs and structured exercise programme
- C. Anti-TNF therapy (adalimumab) and physiotherapy
- D. Oral prednisolone and DMARDs
- E. Sulfasalazine and physiotherapy (Correct Answer)
Explanation: ***Sulfasalazine and physiotherapy*** - **Sulfasalazine** is the preferred **DMARD** for enteropathic arthritis, effectively managing both **peripheral joint involvement** and supporting the underlying **ulcerative colitis**. - **Physiotherapy** and a structured exercise program are crucial for improving **spinal mobility** and addressing the reduced lumbar flexion, as indicated by the **Schober's test**. *Methotrexate and physiotherapy* - **Methotrexate** is generally ineffective for the **axial disease** component (spine and sacroiliac joints) of spondyloarthropathies. - While beneficial for some peripheral arthritis, it's often avoided as a first-line DMARD in patients with active **inflammatory bowel disease** due to potential GI irritation. *NSAIDs and structured exercise programme* - **NSAIDs** are typically first-line for inflammatory back pain but are used with extreme caution in patients with ulcerative colitis due to a significant risk of triggering an **IBD flare**. - Although exercise is important, NSAIDs alone do not provide disease-modifying benefits for progressive **peripheral arthritis** or long-term management in IBD patients. *Anti-TNF therapy (adalimumab) and physiotherapy* - **Anti-TNF agents** like adalimumab are highly effective for both inflammatory bowel disease and spondyloarthritis but are reserved for cases that have **failed conventional DMARD therapy**. - Due to their high cost and potential for serious side effects, including **infections**, they are not considered the initial management step. *Oral prednisolone and DMARDs* - **Oral corticosteroids** are not recommended for the long-term management of spondyloarthritis due to their well-known **systemic side effects**. - While they can manage acute IBD flares, they do not offer a disease-modifying effect for the skeletal manifestations and are not a suitable first-line agent for sustained remission of spondyloarthritis.
Question 15: A 76-year-old woman sustains a trochanteric neck of femur fracture with a reverse oblique pattern on radiographs. She is independently mobile with one stick. Which of the following is the most appropriate surgical fixation method?
- A. Dynamic hip screw with anti-rotation screw
- B. Intramedullary nail (Correct Answer)
- C. Hemiarthroplasty
- D. Cannulated screws
- E. Total hip replacement
Explanation: ***Intramedullary nail*** - A **reverse oblique** fracture pattern is considered highly **unstable** because the fracture line runs from superomedial to inferolateral, leading to a high risk of **medial displacement** of the shaft. - **Long intramedullary (cephalomedullary) nails** are the preferred treatment as they provide superior **biomechanical stability** by acting as a load-sharing device with a shorter lever arm than plates, making them ideal for unstable intertrochanteric fractures, including reverse oblique. *Dynamic hip screw with anti-rotation screw* - A **Dynamic Hip Screw (DHS)** is generally contraindicated for reverse oblique patterns because the sliding mechanism allows the femoral shaft to shift **medially**, causing fixation failure due to the nature of the fracture line. - While effective for stable **intertrochanteric** fractures, using a DHS in this context often leads to **varus collapse** and implant cut-out. *Hemiarthroplasty* - This procedure involves replacing the femoral head and is typically reserved for **displaced intracapsular** hip fractures where there is a significant risk of **avascular necrosis** of the femoral head. - It is not indicated for **extracapsular** trochanteric fractures, which have an excellent blood supply and high potential for **bony healing** with internal fixation. *Cannulated screws* - Cannulated screws are specifically used for **undisplaced or minimally displaced intracapsular** neck of femur fractures, usually in younger, more active patients. - They do not provide the necessary **structural support** or rotational stability required to fix an **unstable extracapsular trochanteric reverse oblique fracture**. *Total hip replacement* - **Total hip replacement (THR)** is usually indicated for active older patients with **displaced intracapsular** fractures or those with pre-existing **osteoarthritis** of the hip. - Like hemiarthroplasty, it is not the standard of care for **extracapsular** trochanteric fractures, which are best managed with internal fixation to preserve the native hip joint.
Question 16: A 64-year-old man presents with a 3-week history of progressively worsening lower back pain. He describes the pain as constant, severe, and unrelieved by rest or analgesia. He has unintentional weight loss of 8kg over 2 months and reports fever and night sweats. He emigrated from Pakistan 15 years ago. Examination reveals tenderness over L3-L4 vertebrae. Temperature is 37.9°C. What is the most likely diagnosis?
- A. Metastatic spinal disease
- B. Spinal tuberculosis (Correct Answer)
- C. Acute mechanical back pain
- D. Ankylosing spondylitis
- E. Spinal epidural abscess
Explanation: ***Spinal tuberculosis*** - Known as **Pott's disease**, it presents with **subacute or chronic back pain**, **fever**, **weight loss**, and **night sweats**, particularly in patients from **endemic regions** like Pakistan. - It commonly involves focal **vertebral tenderness** (e.g., L3-L4) due to anterior vertebral body destruction and can lead to **cold abscess** formation. *Metastatic spinal disease* - While it shares "red flags" like **weight loss** and **constant pain**, it is less likely than TB to present with **fever** and **night sweats** in this clinical context. - It typically targets the **pedicles** of the vertebrae rather than the vertebral bodies and disc spaces often seen in infective processes. *Acute mechanical back pain* - This condition usually follows a **physical trigger** or strain and lacks **constitutional symptoms** such as fever and weight loss. - The pain is typically **relieved by rest**, which is the opposite of the persistent, severe pain reported by this patient. *Ankylosing spondylitis* - This is an **inflammatory arthropathy** that typically presents in **younger patients** (usually <45 years) with pain that **improves with activity**. - It causes **morning stiffness** and is not associated with significant unintentional weight loss or acute fever. *Spinal epidural abscess* - Usually follows a more **acute clinical course** with a much **higher fever** and rapid progression of neurological deficits. - Most patients have specific risk factors such as **intravenous drug use**, recent spinal surgery, or severe **bacteremia** (often Staph aureus).
Question 17: An 81-year-old woman undergoes cemented hemiarthroplasty for a displaced intracapsular neck of femur fracture. During cementation, she develops sudden hypotension (BP 75/40 mmHg), desaturation (SpO₂ 88% on room air), and reduced end-tidal CO₂. What is the immediate management priority?
- A. Administer intravenous adrenaline 1mg
- B. Commence cardiopulmonary resuscitation
- C. Increase inspired oxygen concentration and provide fluid resuscitation (Correct Answer)
- D. Remove the prosthesis immediately
- E. Administer intravenous hydrocortisone 200mg
Explanation: ***Increase inspired oxygen concentration and provide fluid resuscitation*** - The patient is presenting with **Bone Cement Implantation Syndrome (BCIS)**, characterized by sudden hypoxia, hypotension, and a drop in **end-tidal CO₂** during cementation. - Immediate management priority is ABC support: providing **100% oxygen** to combat hypoxia and aggressive **fluid resuscitation** to maintain cardiac output and blood pressure. *Administer intravenous adrenaline 1mg* - High-dose **adrenaline (1mg)** is reserved for cardiac arrest protocols and is not the first-line vasopressor for stable BCIS. - If hypotension persists, small incremental doses of **vasopressors** (like metaraminol or ephedrine) are preferred over full-dose adrenaline. *Commence cardiopulmonary resuscitation* - **Cardiopulmonary resuscitation (CPR)** is only indicated if the patient develops **cardiac arrest** (pulselessness). - Evaluation of the patient's BP (75/40) indicates a pulse is still present, requiring hemodynamics support rather than chest compressions. *Remove the prosthesis immediately* - Once cementation has occurred, removing the prosthesis is technically difficult and will not reverse the **systemic embolization** of marrow or air that has already triggered the syndrome. - Surgical focus should be on completing the procedure as quickly and safely as possible while the **anaesthetist** stabilizes the patient. *Administer intravenous hydrocortisone 200mg* - **Hydrocortisone** is a treatment for **anaphylaxis** or adrenal crisis, neither of which is the primary pathology in BCIS. - BCIS is an **embolic phenomenon** leading to pulmonary hypertension and right heart strain, not a Type I hypersensitivity reaction.
Question 18: A 46-year-old warehouse worker presents to his GP with a 14-week history of lower back pain. The pain is worse in the morning with stiffness lasting approximately 90 minutes. It improves with activity and is worse with rest. He has no red flag symptoms. Inflammatory markers show CRP 42 mg/L and ESR 38 mm/hr. Plain radiographs of the lumbar spine and sacroiliac joints are normal. What is the most appropriate next investigation?
- A. HLA-B27 testing
- B. MRI of the sacroiliac joints (Correct Answer)
- C. CT scan of the lumbar spine
- D. Bone scan
- E. Repeat radiographs in 6 months
Explanation: ***MRI of the sacroiliac joints***- The patient's symptoms of **inflammatory back pain** (worse with rest, improves with activity, morning stiffness >30 minutes, duration >3 months) and elevated **CRP** and **ESR** strongly suggest axial spondyloarthritis.- Since plain radiographs are normal, **MRI of the sacroiliac joints** is the most appropriate next investigation as it is the gold standard for detecting early **sacroiliitis** (e.g., bone marrow oedema), which precedes structural changes visible on X-rays.*HLA-B27 testing*- While a positive **HLA-B27** is associated with axial spondyloarthritis, it is not diagnostic on its own, as many healthy individuals carry the gene, and some patients are HLA-B27 negative.- It's a supportive genetic marker, but not an imaging modality that can confirm active inflammation or sacroiliitis directly.*CT scan of the lumbar spine*- **CT scans** are useful for visualizing bony erosions and chronic structural damage but are less sensitive than MRI for detecting early active **inflammatory oedema**.- This modality also exposes the patient to **ionizing radiation**, making it less favorable than MRI for initial assessment of active inflammation.*Bone scan*- A **bone scan** is sensitive for detecting increased bone turnover but lacks the **specificity** to definitively diagnose axial spondyloarthritis.- It cannot reliably differentiate between various causes of increased uptake in the sacroiliac joints, such as infection, degenerative changes, or specific inflammatory arthropathies.*Repeat radiographs in 6 months*- Waiting for **radiographic progression** would significantly delay the diagnosis, as plain X-rays only show structural damage in later stages of axial spondyloarthritis.- Early diagnosis, facilitated by **MRI**, is crucial for initiating appropriate management and preventing irreversible structural damage and long-term disability.
Question 19: A 72-year-old man sustains a Garden III intracapsular neck of femur fracture. He has a past medical history of atrial fibrillation and is anticoagulated with apixaban. His surgery is delayed by 36 hours to allow for reversal of anticoagulation. What is the primary reason this surgical delay increases his risk of complications?
- A. Increased risk of malunion due to muscle spasm causing further displacement
- B. Development of fat embolism syndrome from bone marrow release
- C. Increased risk of surgical site infection from prolonged immobilization
- D. Higher mortality due to increased thromboembolic events and medical complications (Correct Answer)
- E. Increased risk of avascular necrosis from progressive vascular compromise
Explanation: ***Higher mortality due to increased thromboembolic events and medical complications***- Surgical delay beyond **36 hours** is strongly associated with increased **mortality** and a higher incidence of medical complications like **pneumonia**, **pressure sores**, and **UTIs**.- Prolonged immobilization leads to a significantly higher risk of **venous thromboembolism (VTE)**, which is a major cause of post-operative morbidity in elderly hip fracture patients.*Increased risk of malunion due to muscle spasm causing further displacement*- **Malunion** is a long-term healing complication rather than an acute medical risk associated with the timing of surgery.- Neck of femur fractures are usually treated with **arthroplasty** or **internal fixation**, where the risk of malunion is independent of a 36-hour delay.*Development of fat embolism syndrome from bone marrow release*- **Fat embolism syndrome** is typically an early complication occurring shortly after the trauma or during **intraoperative manipulation** of the medullary canal.- It is not specifically categorized as the primary medical risk factor driven by the **pre-operative delay** of 36 hours.*Increased risk of surgical site infection from prolonged immobilization*- While prolonged hospital stays can increase exposure to **nosocomial pathogens**, immobilization itself is not the direct primary cause of **surgical site infections (SSI)**.- Systemic medical decline and **thromboembolic events** provide a much more significant contribution to the mortality associated with surgical delays.*Increased risk of avascular necrosis from progressive vascular compromise*- Although **avascular necrosis (AVN)** is a risk in **intracapsular fractures**, the primary damage to the blood supply occurs at the **time of injury**.- While early reduction is preferred, the increased **mortality rate** from medical complications is the more urgent systemic concern cited in surgical guidelines for these patients.
Question 20: A 67-year-old woman presents to the Emergency Department following a fall. She has a shortened and externally rotated leg. Radiographs confirm a displaced intracapsular neck of femur fracture. She has a history of chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) and rheumatoid arthritis treated with methotrexate. She was independently mobile pre-injury. Which of the following is the most appropriate surgical management?
- A. Uncemented hemiarthroplasty (Correct Answer)
- B. Cemented hemiarthroplasty
- C. Total hip replacement
- D. Cannulated screw fixation
- E. Dynamic hip screw fixation
Explanation: ***Uncemented hemiarthroplasty*** - In patients with **severe chronic kidney disease (Stage 4 CKD)**, there is an elevated risk of **Bone Cement Implantation Syndrome (BCIS)**, which uncemented fixation avoids. - For a **displaced intracapsular femoral neck fracture** in an independently mobile elderly patient, replacement (hemiarthroplasty) is required to prevent **avascular necrosis** and allow early mobilization. *Cemented hemiarthroplasty* - While often used in elderly patients, the patient's **Stage 4 CKD** significantly increases the risk of **cardiovascular collapse** due to **BCIS** during cement polymerization. - The systemic release of vasoactive substances from bone cement can cause profound **hypotension** and cardiorespiratory compromise, which is poorly tolerated in patients with **renal impairment**. *Total hip replacement* - This option is generally reserved for healthier, more active individuals with **high functional demand** or pre-existing hip osteoarthritis. - Given the patient's **CKD stage 4** and **rheumatoid arthritis**, a total hip replacement carries higher risks of surgical complexity, blood loss, **dislocation**, and periprosthetic infection compared to hemiarthroplasty. *Cannulated screw fixation* - This technique is primarily indicated for **undisplaced** or minimally displaced intracapsular fractures. - For a **displaced intracapsular fracture** in a 67-year-old, fixation has an unacceptably high rate of failure, including **non-union** and **avascular necrosis**. *Dynamic hip screw fixation* - A **Dynamic Hip Screw (DHS)** is the treatment of choice for **extracapsular (intertrochanteric)** fractures. - It is not suitable for an **intracapsular fracture** as it does not address the disrupted **blood supply** to the femoral head, leading to a high risk of **avascular necrosis**.
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