Post-Fracture Care After COVID-19 Mobility Restrictions in Older Adults with Femoral Neck Fracture: A Retrospective Pre–Post Study

Background: COVID-19-related mobility restrictions may have affected physical activity and post-fracture care in older adults. This study compared outcomes before and after age-based mobility restrictions, focusing on reported activity, documented combined postoperative physiotherapy and anti-osteoporotic pharmacologic treatment, and secondary fragility fractures. Methods: This retrospective single-center pre–post study included patients aged 65 years or older who underwent bipolar hemiarthroplasty for low-energy osteoporotic femoral neck fracture. Patients treated during the year before restrictions were compared with those treated during the post-restriction year. Outcomes included reported pre-fracture activity category, all-cause mortality, mobility among survivors, documented combined postoperative physiotherapy and anti-osteoporotic pharmacologic treatment, and secondary fragility fractures. Results: The pre-pandemic and post-restriction groups included 65 and 122 patients, respectively. Regular outdoor walking/activity before fracture was less frequent in the post-restriction group than in the pre-pandemic group (45.1% vs. 72.3%; p < 0.001), whereas home-limited activity was more frequent (54.9% vs. 27.7%). All-cause mortality during follow-up was 24.6% and 29.5%, respectively (p = 0.499). Mobility among survivors did not differ significantly (p = 0.832). Among survivors, documented combined postoperative physiotherapy and anti-osteoporotic pharmacologic treatment was uncommon: 14.3% and 17.4%, respectively (p = 0.809). Secondary fragility fractures were recorded only in the post-restriction group (8/86 survivors, 9.3%; p = 0.051). Conclusions: In this retrospective pre–post comparison, the post-restriction group showed a lower proportion of reported outdoor activity, while documented combined postoperative physiotherapy and anti-osteoporotic pharmacologic treatment remained uncommon among survivors. Secondary fragility fractures were observed only in the post-restriction group and should be interpreted with caution, given the exploratory design and limited number of events. Structured rehabilitation referral, osteoporosis treatment, fall-prevention strategies, and follow-up pathways remain important components of post-fracture care following femoral neck fracture.