Background: Femoral neck fractures present a significant challenge in orthopedic surgery, with surgeon experience being a critical factor in surgical outcomes. However, the impact of experience level on key perioperative metrics remains debated. This study evaluates the relationship between surgeon experience and clinical outcomes in femoral neck fracture management.

Methods: A retrospective, single-center cohort study analyzed 408 patients who underwent surgical treatment for femoral neck fractures. Surgeons were categorized into four groups based on experience level: Residents (n=96), Intermediate stage (n=49), Young residents (n=178), and Senior attendings (n=85). Primary outcomes included mortality, secondary surgeries, blood transfusion requirements, and reduction technique selection. Statistical analyses were performed using ANOVA, Kruskal-Wallis, and Pearson’s chi-square tests, with significance at p<0.05.

Results: overall mortality rates were similar across all groups (p=0.80). Secondary surgeries were significantly more frequent among Attending surgeons (23.5%) than Intermediate-stage surgeons (14.3%, p=0.019). Reduction technique selection varied significantly, with Residents (32.3%) and Senior attendings (30.6%) performing open reductions more frequently than Young residents (19.1%) (p=0.049). Pain scores, hemoglobin levels, and blood transfusion rates were comparable across all experience levels (p>0.05). No intraoperative mortality occurred in any group.

Conclusion: This study demonstrates that surgeon experience influences procedural selection in femoral neck fracture management but does not significantly affect overall mortality, pain scores, or transfusion rates. The higher rate of secondary procedures among attending surgeons likely reflects appropriate case selection rather than differences in surgical skill. These findings reinforce the safety and effectiveness of supervised resident participation in femoral neck fracture surgery, highlighting opportunities to improve surgical training protocols and standardize decision-making processes.

Keywords: Femoral neck fracture, surgeon experience, surgical training, orthopedic surgery, resident supervision, surgical outcomes