Which of the following best describes the management principle for a nondisplaced femoral neck fracture in the elderly?

• A. Internal fixation with cancellous screws to preserve the native joint
• B. Total hip arthroplasty in all cases
• C. External fixation
• D. Cast immobilization

Answer: (A)

For a nondisplaced femoral neck fracture in the elderly, the aim is to preserve the native hip and allow early mobilization with stable fixation. Internal fixation using cancellous screws across the fracture provides this stability while keeping the femoral head intact and maintaining its blood supply. This approach minimizes the risks and recovery demands associated with joint replacement and avoids the immobilization and pin-site issues tied to external fixation or long-cast strategies. Total hip arthroplasty is generally reserved for displaced fractures or situations where joint preservation isn’t feasible due to bone quality or preexisting joint disease, not for nondisplaced fractures.