Clinical presentation With the aging of society, the incidence of osteoporosis and resulting femoral neck fractures is gradually increasing. Clinically, fractures in people older than 60 years of age are generally regarded as geriatric femoral neck fractures. Elderly patients with femoral neck fractures are often associated with a variety of complications, such as hypertension, heart disease, cerebrovascular disease, and diabetes mellitus. If these patients are not treated in time, they will not be able to recover their preoperative activity as quickly as possible. Due to the pain, swelling and deformity of the fractured hip, they will not be able to move around, and long-term bed rest will cause the patient’s general health condition to deteriorate rapidly, with serious complications such as crushing pneumonia, decubitus ulcer, deep venous infection and pulmonary embolism, urinary tract infection, and even death. The fracture becomes a turning point in the deterioration of the health status of such patients. Diagnosis Generally, there is pain typical of fractures, shortened external rotation deformity of the lower limbs, and hip dysfunction, but the above-mentioned manifestations are atypical in insertional femoral neck fractures, leading to clinical omission. X-rays: frontal and lateral radiographs are required to clarify the diagnosis and fracture typing. CT: If the diagnosis cannot be made clearly by X-ray, CT can be added. MRI: It can assist in the diagnosis. Treatment I. Non-surgical treatment For femoral neck fracture in the elderly, the goal of treatment is to eliminate pain, early activity, reduce various complications caused by bed rest, improve life treatment and reduce the death rate. Among them, early pain-free activity is the key, so unless the patient has contraindications to surgery. In principle, bedridden traction is not advocated for conservative treatment. Surgical treatment As far as possible, surgical treatment is an effective method to eliminate pain and achieve early activity when the physical condition allows. Studies have confirmed that surgical treatment can greatly increase the survival time and survival treatment of patients compared with non-surgical treatment. Even for patients who were unable to walk before the fracture, surgical treatment can reduce pain and facilitate care. Surgical treatment includes internal fixation, artificial femoral head replacement and total hip replacement. The choice of method depends on the patient’s age, fracture type, quality of bone, health status, activity level and other factors. 1. Internal fixation Femoral neck fractures without displacement (garden I, II) can be treated by internal fixation, mostly with three hollow threaded nails. Internal fixation has the advantages of low surgical bleeding, short duration, low incidence of infection and low price. However, there is a risk of fracture non-union, femoral head necrosis and reoperation with internal fixation. 2.Hip arthroplasty For displaced femoral neck fracture (garden III, IV), hip arthroplasty should be preferred. The surgical methods are divided into artificial bipolar femoral head replacement and artificial total hip arthroplasty. (1) Artificial bipolar femoral head replacement Generally speaking, if the patient is particularly old and has a short life expectancy, poor general health, many comorbidities, weak muscle strength especially with sequelae of cerebrovascular disease, less activity requirements and poor intelligence and unclear mind, half hip replacement is appropriate. Half hip replacement surgery is less traumatic, shorter and dislocation rate is lower, but the life span of the prosthesis is about 5 years. (2) Artificial total hip arthroplasty If the patient’s general condition is good, total hip arthroplasty can be considered. Cemented total hip prosthesis can provide good immediate fixation and allow early weight bearing, which is especially important for elderly patients. However, the lifespan of the prosthesis is shorter than that of non-cemented prostheses. It is suitable for patients with osteoporosis. Non-cemented prostheses allow bone tissue to grow into the micro-pores on the surface of the prosthesis to achieve good fixation when the bone quality is good. For younger patients with less pronounced osteoporosis and longer life expectancy, uncemented fixation, or uncemented fixation on the acetabular side and cemented fixation on the femoral stem, may be used. It is also emphasized that for femoral neck fractures in the elderly, not only surgical treatment of the fracture itself is required, but also treatment of the primary osteoporosis to reduce bone resorption, increase bone formation, and improve bone quality. Reducing re-fractures or fractures in other areas. One survey showed that 88% of patients were treated for femoral neck fractures without any treatment for the primary osteoporosis. These treatments include the use of calcium, vitamin D, calcitonin, etc.