## Analysis of Intracapsular Neck of Femur Fracture Management ### Why Option 1 (Index) is INCORRECT **Key Point:** Internal fixation with cannulated screws is NOT the preferred treatment for ALL displaced intracapsular fractures. The choice depends critically on **patient age and fracture displacement**. - **Young patients (< 60 years):** Cannulated screws or dynamic compression plating is appropriate to preserve the femoral head. - **Elderly patients (> 60 years with displaced fracture):** Hemiarthroplasty or total hip arthroplasty is preferred because the risk of AVN and non-union is high, and the patient's life expectancy may not justify salvage attempts. - **Undisplaced fractures:** Internal fixation with screws is acceptable across all age groups. ### Why the Other Options are CORRECT | Feature | Evidence | |---------|----------| | **AVN Risk** | Intracapsular fractures disrupt the blood supply within the joint capsule; extracapsular fractures preserve extraosseous blood supply. AVN incidence: intracapsular 10–30%, extracapsular < 5%. | | **Blood Supply** | Medial femoral circumflex artery (MFCA) is the dominant blood supply to the femoral head; lateral FCCA is secondary. | | **Garden Classification** | Grade I–IV system grades displacement and angulation; used to guide prognosis and treatment. | **High-Yield:** The treatment algorithm for intracapsular NOF fractures is **age-dependent**, not uniform. This is a common NEET PG trap. **Clinical Pearl:** A 70-year-old with a displaced intracapsular fracture should be counselled for arthroplasty, not internal fixation, because the femoral head is at high risk of ischaemic collapse. [cite:Rockwood & Green's Fractures in Adults Ch 53]
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