An 82-year-old female with a history of osteoporosis presents after a fall, complaining of severe right hip pain and inability to bear weight. Radiographs confirm a displaced Garden's Type IV fracture of the right femoral neck. Given her age and fracture type, the most appropriate definitive surgical management is:

Explanation

In elderly patients (typically >65-70 years old) with displaced femoral neck fractures (Garden's Type III or IV), the risk of avascular necrosis and non-union after internal fixation is very high, leading to poor outcomes. Therefore, arthroplasty is generally preferred. Hemiarthroplasty (replacement of the femoral head and neck) is the most common treatment for displaced femoral neck fractures in less active elderly patients, as it provides immediate stability and allows early mobilization. Total Hip Arthroplasty (THA) is often considered for more active elderly patients, those with pre-existing symptomatic hip arthritis, or those with good bone stock, as it offers better functional outcomes but has a higher dislocation risk. Closed reduction and percutaneous pinning is generally reserved for non-displaced or minimally displaced fractures, or in very frail patients where arthroplasty is contraindicated. Non-operative management is associated with high morbidity and mortality in this population.