Outcomes of immediate versus delayed weight-bearing after cannulated screw fixation for valgus-impacted and nondisplaced femoral neck fractures in older adults.

Abstract

Valgus-impacted and nondisplaced femoral neck fractures in older adults are commonly treated with cannulated screw fixation. However, the optimal timing for initiating postoperative weight-bearing remains controversial. This study aimed to compare immediate weight-bearing (IWB) as tolerated versus delayed weight-bearing (DWB) to determine whether IWB could improve patient outcomes without increasing the risk of surgical complications. A total of 136 patients aged 65 years or older with valgus-impacted or nondisplaced femoral neck fractures treated using three cannulated screws were retrospectively analyzed. The patients were divided into two groups: the IWB group, which began weight-bearing on the first postoperative day and the DWB group, which started weight-bearing six weeks after surgery. All patients were followed for a minimum of 12 months. Outcome measures consisted of surgical complications, perioperative complications, postoperative length of hospital stay (LOS), and functional recovery evaluated with the Modified Barthel Index (MBI) and the Harris Hip Score (HHS). No significant differences were observed in surgical complications between the two groups. The IWB group had a lower overall perioperative complication rate (6.2 % vs. 18.1 %, p = 0.035) and shorter postoperative LOS (4.9 ± 1.6 vs. 5.6 ± 1.9 days, p = 0.028) than the DWB group. The MBI and HHS were higher in the IWB group at 1 and 3 months postoperatively, while the differences were not statistically significant at 6 and 12 months. For older patients with valgus-impacted or nondisplaced femoral neck fractures, immediate weight-bearing as tolerated following cannulated screw fixation may have a positive effect on reducing perioperative complications, shortening postoperative LOS, and promoting early functional recovery, without increasing surgical complications.