& x20;In femoral neck fracture management using the Garden classification, which treatment is indicated for a… - INI-CET EXAM -2026

INI-CET EXAM -2026

Medical Surgical Nursing

Hard

Appeared in: INI-CET EXAM -2026

Explanation

For displaced femoral neck fractures (Garden types III and IV), which are common in the elderly, the blood supply to the femoral head is compromised.
Hemiarthroplasty replaces the damaged femoral head, bypassing the risks of non-healing (non-union) and bone death (avascular necrosis) associated with internal fixation in these cases.
It is a less extensive surgery than a total hip replacement, making it a safer option for many elderly patients with comorbidities.
This procedure allows for immediate post-operative weight-bearing, which is critical for reducing the severe complications of prolonged immobility in older adults.

Option A: Cannulated screws are a form of internal fixation. This method is not suitable for displaced femoral neck fractures (Garden III/IV) in the elderly due to a high risk of fixation failure, non-union, and avascular necrosis.
Option B: While a valid treatment, Total Hip Replacement (THR) is generally not the first choice for all elderly patients. It is a more extensive surgery than a hemiarthroplasty with a slightly higher risk of complications like dislocation.
Option D: Conservative (non-surgical) management is rarely the best option for an elderly patient with a femoral neck fracture who was previously mobile. The risks associated with prolonged immobility (pneumonia, DVT, pressure sores, muscle wasting) are often greater than the risks of surgery.

Clinical Relevance

Nursing practice connection: Use the key finding related to Surgical management of femoral neck fractures in elderly patients to guide bedside assessment, documentation, and the next nursing action.
Post-operative nursing care is critical for patients after hemiarthroplasty. Key priorities include pain management, preventing DVT (e.g., anticoagulants, compression stockings), preventing hip dislocation (using an abduction pillow, avoiding extreme flexion), and encouraging early mobilization to prevent respiratory and other complications.
Nurses play a vital role in assessing the neurovascular status of the affected limb post-surgery, monitoring for signs of infection at the incision site, and managing the patient's overall recovery.
What if? If the patient was a very active 70-year-old with pre-existing painful hip arthritis, a Total Hip Replacement (THR) would likely be the preferred option to provide better long-term function and address the arthritic pain in the socket.

How to Approach the Question

First, identify the key elements of the question: the condition (femoral neck fracture), the patient population (elderly), and the context (Garden classification).
Recall that treatment for this fracture is highly dependent on two factors: the degree of fracture displacement and the patient's pre-fracture activity level.
For an 'elderly patient' with a displaced fracture (the most common scenario requiring surgery), the options are arthroplasty (replacement) rather than fixation (screws). This helps eliminate 'Cannulated screws'.
Differentiate between the two arthroplasty options. Hemiarthroplasty is a less complex procedure for the typical, less active elderly patient. THR is for more active elderly patients or those with pre-existing arthritis.
Conclude that for a general 'elderly patient' without further qualifying information, hemiarthroplasty is the standard and most broadly indicated treatment.

Concept Tested & Keywords

Concept Tested: Surgical management of femoral neck fractures in elderly patients.
Stem keywords: femoral neck fracture, Garden classification, elderly patient, treatment
Lead-in keywords: indicated for
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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