Objective To develop and validate a predictive model for postoperative rehabilitation outcomes in elderly patients with femoral neck fractures using rehabilitation training based on the LEARNS model.Methods A prospective study was conducted on 109 elderly patients with femoral neck fractures who received rehabilitation training based on the LEARNS model between January 2019 and April 2023 at The Ninth People's Hospital of Wuxi (study group). Another 109 age- and gender-matched elderly patients who received conventional rehabilitation training were selected as the control group. The hip joint functional recovery outcomes were evaluated 3 months post-surgery. Factors influencing postoperative rehabilitation outcomes in elderly patients were analyzed. A nomogram prediction model was constructed for rehabilitation outcomes based on the LEARNS model, and the model's predictive performance and validation were assessed.Results A total of 89 patients achieved good to excellent hip joint function recovery. Multivariate stepwise logistic regression analysis identified osteoporosis [O^R =3.892 (95% CI: 1.602, 9.460)], the timing of rehabilitation intervention post-surgery [O^R =5.023 (95% CI: 2.067, 12.207)], lateral surgical approach [O^R =4.076 (95% CI: 1.677, 9.905)], and lower limb deep vein thrombosis [O^R =4.047 (95% CI: 1.665, 9.836)] as significant risk factors affecting rehabilitation outcomes (P <0.05). The constructed nomogram prediction model had a total score range of 84-357, corresponding to a risk rate range of 0.05-0.80. Model validation showed a C-index of 0.802 (95% CI:0.761, 0.837), with the calibration curve closely aligning with the ideal curve (P >0.05). The receiver operating characteristic (ROC) curve analysis indicated a sensitivity of 85.00% (95% CI:0.611, 0.960) and specificity of 82.02% (95% CI:0.722, 0.891), with an area under the curve (AUC) of 0.872 (95% CI:0.795, 0.949).Conclusion The nomogram prediction model based on LEARNS model rehabilitation training demonstrates good predictive performance for postoperative rehabilitation outcomes in elderly patients with femoral neck fractures.