Fractures of the femoral neck are a common type of fracture in the middle-aged and elderly population, most commonly in those over 60 years of age, and most occur in association with osteoporosis. In older adults with osteoporosis, these fractures can occur in low-energy injuries such as a slip or fall on flat ground, and these osteoporosis-related fractures are also known as fragility fractures. Fractures of the femoral neck are the most symptomatic and difficult to treat of the osteoporotic fractures, and because of their high incidence, they cause a much higher social burden than all other types of fragility fractures. Most of the femoral neck is located in the joint capsule of the hip joint, and after the fracture, it loses most of its blood supply, which makes it easy for the fracture to fail to heal, and even if it heals, there is a high probability of ischemic necrosis of the femoral head at a later stage. The clinical classification of femoral neck fractures is usually based on the Garden’s typology, where types I and II are less displaced and have a slightly lower probability of late femoral head necrosis, while types III and IV are more displaced and have a higher probability of late femoral head necrosis. The treatment of osteoporotic femoral neck fractures can be divided into two major strategies: conservative treatment and surgical treatment. For the less displaced Garden I and II fractures, conservative treatment, i.e., non-operative treatment, can be used, but it requires up to three months of bed rest, which can cause great pain and suffering to the patient, and complications such as bed sores, pneumonia, urinary tract infections, etc. are not only high but also difficult to cure, often leading to death. However, many patients eventually die of bed collapse due to physical exertion or incurable complications. The literature reports that the mortality rate of proximal femur fractures within one year of conservative treatment is roughly 30-50%. On the other hand, because China is not yet ready to enter an aging society, there is an extreme shortage of geriatric care beds, so the long-term care of similar patients is mainly undertaken by the family, and this professionally demanding and extremely heavy workload is not affordable for the average family. Type III and IV fractures are more displaced and fracture healing is usually difficult to occur with conservative treatment. Therefore, the main treatment for proximal femur fractures is surgery, and as long as the patient has no clear contraindications to surgery, that is, the patient’s body has no obvious difficulty in withstanding surgery, then all should be treated surgically; of course there are some patients who are in the middle ground, medically known as relative contraindications to surgery, their physical condition is not the best, but not so bad that they cannot be operated at all, s to In this case, it is necessary for the doctor and the family to discuss and make decisions together. Usually, the surgical ability and overall strength of a strong general hospital will be stronger, and if it is difficult to operate in a small or medium-sized hospital, you can transfer to a large hospital and have more chances. In addition, the timing of surgery is very important. After a fracture occurs in an elderly person, there will be severe pain, but it is necessary to transfer to the hospital, film examination and other kinds of movements, and there will be urination and defecation and the corresponding cleaning and hygiene work, to prevent bed sores must be turned regularly, etc. All these activities will cause changes in body position and limbs, resulting in severe pain. All of these activities will cause changes in position and limb, resulting in severe pain. This pain will severely deplete the patient’s energy and affect his or her appetite, thus “increasing” the risk of surgery. The word “increasingly” does get worse every day, so in principle, the sooner the surgery is performed, the better. According to the patient’s previous health condition and the convenience of surgical preparation, if you can operate within 24 hours, do not delay until the next day; if you can operate within 3 days, do not delay until 3 days later; in any case, try to complete the operation within a week, and if you have difficulties, do not exceed 2 weeks. After 2 weeks of bed rest, the complication rate after surgery will increase exponentially because of the serious physical exertion of the patient, and basically the chance of surgery will be lost. Therefore, it is important for the family to make a prompt decision in the face of this unexpected event, and not to miss the opportunity because of hesitation. The primary goal of surgical treatment of osteoporotic femoral neck fractures is to restore the patient’s mobility as early as possible, with the minimum goal of enabling the patient to move painlessly in bed to facilitate care. The specific surgical plan is usually determined by the surgeon based on the degree of fracture displacement, as well as the patient’s age, physical ability, pre-fracture status, and prior osteoarthritis of the hip, among which the degree of fracture displacement is the most important determinant. For Garden type I and II femoral neck fractures, since the possibility of secondary ischemic necrosis of the femoral head is relatively small, internal fixation treatment is generally recommended, and internal fixation systems such as threaded nails or powered hip screws can be used. Slippage of the nail end due to attractive settlement of the fracture end is also more common. In elderly people over 65 years of age with Garden III and IV femoral neck fractures, the incidence of ischemic necrosis of the femoral head is very high due to the significant displacement and the severely impaired blood supply to the femoral head, which is usually no longer suitable for internal fixation with threaded nails and requires artificial joint replacement. For most of the patients who are physically fit and have a long life expectancy, total hip replacement surgery is suitable, which means that not only the fractured femoral head neck is replaced with an artificial joint, but also the corresponding acetabular part above is replaced with a corresponding artificial acetabulum, so that the two corresponding friction surfaces match each other and can be used for a long time. The total hip replacement surgery is a little bigger than the threaded nail surgery, but at present, the artificial joint surgery in major hospitals nationwide has been specialized, and for a specialized surgeon who only performs one or two types of surgery all year round, the total hip replacement surgery takes about one hour, and the overall trauma is not much greater than that of the half hip surgery, and most patients can recover quickly after the surgery. For patients who are frail, have more comorbid diseases and are already less mobile, they can opt for hemi hip replacement surgery, which involves replacing only the distal femoral head neck and keeping the acetabular part above, using an artificial metal femoral head of the same diameter as the original femoral head to correspond to the natural acetabulum, making a mobile joint. The advantages of hemiarthroplasty are that the operation is smaller than total hip replacement, the operation time is shorter, and the patient’s tolerance is higher. The disadvantage of hemiarthroplasty is that the frictional properties of the metal femoral head are very different from those of the natural femoral head, and long-term heavy use may cause further wear and tear of the upper acetabulum, which may require further surgical revision to a total hip replacement. Therefore, the surgical indications for hemiarthroplasty are generally more strictly controlled, but of course, there is still some academic controversy about this. Regardless of the means used, the purpose of surgery is to fix the fracture well or to restore the normal function of the joint with an artificial joint, and to restore the patient’s mobility as soon as possible after surgery according to the quality of the bone and the stability of the internal fixation. For patients with poor health and many comorbidities, the rehabilitation process needs to be delayed, but at least pain-free bedside training can be achieved to reduce patient pain, facilitate care, and minimize the occurrence of bedside complications. And a truly complete rehabilitation process starts with preoperative or even pre-hospital education. Therefore, it can be seen that the overall goal of the treatment strategy for osteoporotic femoral neck fractures is to minimize the patient’s bed rest and restore his or her mobility as soon as possible. The specific means of treatment is to actively pursue early surgery and early rehabilitation. In addition, as with all other diseases, prevention is always more important than treatment. The prevention of osteoporotic femoral neck fractures focuses on osteoporosis, on the one hand, comprehensive drug therapy, and on the other hand, reasonable mental and physical exercise to maintain agility and coordination and prevent falls. From the perspective of osteoporosis treatment, once a fracture occurs in a postmenopausal woman or a man over 70 years of age, the diagnosis of osteoporosis is established and the corresponding follow-up medication is required. Moreover, once a patient is bedridden, he or she will suffer from rapid bone calcium loss. The literature reports that a week of bed rest in a fracture patient results in bone calcium loss equivalent to that of a year in a normal elderly person. Many people simply equate osteoporosis treatment with “calcium supplementation”, which is far from adequate. It is important to emphasize that osteoporosis is not a simple pathological process and therefore requires a combination of medications and measures to treat it, as well as a healthy lifestyle.