#june2020amc1
An 80-year-old man who normally walks short distances with a frame and has a past medical history of angina and diabetes, falls and sustains a displaced intracapsular hip fracture. Which of the following is the most appropriate definitive management for him?
A. Bed rest and traction applied to the injured leg
B. Surgery to perform a dynamic hip screw
C. Surgery to perform a hip hemiarthroplasty
D. Surgery to perform a total hip replacement
E. Surgery to perform open reduction and internal fixation with cannulated screws.
Explanatory Notes:
This is an intracapsular fracture and therefore the blood supply to the head is deemed to be damaged and therefore the most appropriate treatment is to removed the head and perform a hemiarthroplasty. This allows the patient to be mobilised and reduces analgesic requirements. A dynamic hip screw is appropriate for extra capsular fractures where the blood supply to the head is presumed intact. He would not be suitable for a total hip replacement due to his co morbidities and limited mobilisation. Cannulated screws are performed when trying to preserve the femoral head such as in young patients or minimally displaced intracapsular fractures where the blood supply is more likely to remain intact. They may also require the patient to be less than full weight bearing and so are not ideal in elderly people who require frames to walk. Bed rest and traction is reserved for the very few numbers of patients who remain unfit for an anaesthetic despite optimisation.
An 80-year-old man who normally walks short distances with a frame and has a past medical history of angina and diabetes, falls and sustains a displaced intracapsular hip fracture. Which of the following is the most appropriate definitive management for him?
A. Bed rest and traction applied to the injured leg
B. Surgery to perform a dynamic hip screw
C. Surgery to perform a hip hemiarthroplasty
D. Surgery to perform a total hip replacement
E. Surgery to perform open reduction and internal fixation with cannulated screws.
Explanatory Notes:
This is an intracapsular fracture and therefore the blood supply to the head is deemed to be damaged and therefore the most appropriate treatment is to removed the head and perform a hemiarthroplasty. This allows the patient to be mobilised and reduces analgesic requirements. A dynamic hip screw is appropriate for extra capsular fractures where the blood supply to the head is presumed intact. He would not be suitable for a total hip replacement due to his co morbidities and limited mobilisation. Cannulated screws are performed when trying to preserve the femoral head such as in young patients or minimally displaced intracapsular fractures where the blood supply is more likely to remain intact. They may also require the patient to be less than full weight bearing and so are not ideal in elderly people who require frames to walk. Bed rest and traction is reserved for the very few numbers of patients who remain unfit for an anaesthetic despite optimisation.
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