Question

The treatment of choice in grade 4 subcapital fractured neck of femur in a fifty year old patient is

• A. Pin-in-situ
• B. Reduction
• C. Hemiarthroplasty
• D. Total hip replacement

Hint:

When fixation is unreliable in a displaced subcapital fracture, think head replacement.

Answer 1

The Correct Option is C

This question checks what is done for a fully displaced (grade 4) femoral neck fracture close to the hip joint in a middle aged patient.

1. Pin-in-situ: This holds the fracture without correcting displacement and needs the head to heal on its own blood supply, which is already damaged here, so it is unreliable.
2. Reduction: Realigning and fixing the fragments still depends on the torn blood vessels recovering, so union and head survival are uncertain in a grade 4 injury.
3. Hemiarthroplasty: This removes the damaged head and replaces it with an implant, sidestepping the blood supply problem entirely and giving quick, dependable relief.
4. Total hip replacement: This also treats the hip socket and is saved for patients who already have arthritis there or who are very active, which is not described in this case.

The correct choice is hemiarthroplasty, because the femoral head's blood supply is already lost in a grade 4 fracture, so replacing the head is safer than hoping it heals.

Let's summarize:

• A grade 4 subcapital fracture means the femoral head has likely lost its blood supply.
• Fixation methods rely on healing that may not happen, while hemiarthroplasty removes that risk.

So hemiarthroplasty is the treatment of choice here.