Cemented versus Uncemented Hemiarthroplasty in Femoral Neck Fractures: A Comparative Case Series Using Singh Index...

Femoral neck fractures in elderly patients require careful consideration of both bone quality and perioperative risk when selecting between cemented and uncemented hemiarthroplasty. Singh index provides a simple radiographic assessment of trabecular bone quality. This study evaluates its utility in guiding fixation type selection in high-risk patients.

This retrospective comparative case series included 18 elderly patients with displaced femoral neck fractures treated with hemiarthroplasty. Patients were stratified based on Singh index, with those who had a score of ≥4 undergoing uncemented fixation and those with a score <4 undergoing cemented fixation. All patients were classified as American Society of Anesthesiologists Grade III or IV. Functional outcomes were assessed using the Harris Hip Score at follow-up.

Pre-operative decision-making based on Singh index correlated with intraoperative findings in 16 out of 18 cases (88.9%). In two cases, intraoperative assessment necessitated a change from uncemented to cemented fixation due to poor bone quality. At a mean follow-up of 6 months, the mean Harris Hip Score was 82.4 in the uncemented group and 78.6 in the cemented group. No cases of bone cement implantation syndrome were observed in the uncemented group, supporting safer fixation selection in high-risk patients.

Singh index is a useful and practical tool for guiding fixation choice in hemiarthroplasty. In high-risk patients with adequate bone quality, uncemented fixation provides satisfactory functional outcomes while avoiding cement-related complications.