Treatment for fracture neck of femur in a 70 year old patient with avascular necrosis of head of femur?
The correct answer is likely hemiarthroplasty. Why? Because in elderly patients with displaced femoral neck fractures and existing avascular necrosis, internal fixation (like with screws) isn't the best option because the blood supply is already compromised, leading to high non-union rates. Hemiarthroplasty replaces the femoral head, avoiding the need for healing and reducing the risk of avascular necrosis. Total hip arthroplasty might be considered if there's pre-existing arthritis, but in this case, the question doesn't mention arthritis, so hemiarthroplasty is more standard.
Now, the wrong options. Let's say the options include internal fixation (like Option A), total hip arthroplasty (Option B), and maybe valgus osteotomy (Option C). Internal fixation (A) is incorrect because it's used for nondisplaced fractures with good blood supply. In displaced fractures or with avascular necrosis, it's not suitable. Total hip arthroplasty (B) is wrong unless there's existing arthritis. Valgus osteotomy (C) is outdated and not used in elderly patients with displaced fractures. Another option might be observation (D), which is obviously wrong.
Clinical pearl: Remember that in displaced femoral neck fractures in elderly patients, especially with avascular necrosis, hemiarthroplasty is the go-to. Avoid internal fixation here due to non-union risks. Also, the presence of avascular necrosis makes the head more prone to collapse, so replacement is better.
Need to structure this into the required sections. Make sure each part is concise and fits within the character limit. Use bold for key terms. Check that all sections are included and the correct answer is clearly stated at the end.
**Core Concept**
Fractures of the femoral neck in elderly patients with avascular necrosis (AVN) of the femoral head require surgical intervention to prevent nonunion and collapse. The compromised blood supply to the femoral head in AVN worsens with displacement, making anatomical healing unlikely. Treatment prioritizes prosthetic replacement over fixation.
**Why the Correct Answer is Right**
Hemiarthroplasty is the standard treatment for displaced femoral neck fractures in elderly patients with AVN. It avoids reliance on the fragile blood supply to the femoral head, which is already compromised in AVN. By replacing the femoral head with a prosthesis, the need for healing is bypassed, reducing the risk of nonunion and AVN progression. This approach also allows early mobilization, critical for elderly patients to prevent complications like DVT or pneumonia.
**Why Each Wrong Option is Incorrect**
**Option A: Internal fixation (e.g., cannulated screws)** – Incorrect. Fixation is contraind