Effect of Postoperative Weightbearing on Intracapsular Femoral Neck Fractures Treated with The Femoral Neck System: A Comparative Cohort Study.

Background: Postoperative weightbearing management of patients surgically treated for femoral neck fractures is controversial. This study aimed to compare the outcomes of patients treated with a fixed-angle implant, the Femoral Neck System (FNS), as a function of their postoperative weightbearing protocol. Methods: A comparative cohort study of patients with intracapsular femoral neck fractures who underwent fixation with the FNS at a Level I trauma center from 2019 to 2023 was conducted. Patients were assigned to either the weightbearing as tolerated (WBAT) group or the toe-touch weightbearing (TTWB) group based on surgeon preference after each procedure. Primary outcome measures were postoperative complications and the need for revision surgery. Secondary outcomes included visual analog scale (VAS) pain score, SF-12 score, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. Results: There were 25 patients in the WBAT group and 19 in the TTWB group. Ten of 25 (40%) fracture union complications occurred in the WBAT cohort compared with 6 of 19 (32%) in the TTWB group (p = 0.565). Revision surgeries were required in 7 of 25 cases (28%) in the WBAT cohort compared with 3 of 19 (16%) in the TTWB group (p = 0.339). No statistically significant differences in VAS pain scores, SF-12 scores, or WOMAC scores between the groups were found. Conclusion: There were no statistically significant differences in radiographic complications, reoperations, or functional outcome scores between the two postoperative weightbearing protocols. Our findings suggest that WBAT may be permitted in this patient cohort, thereby simplifying postoperative care for patients and surgeons. Level of Evidence: III.