A 72-year-old woman was seen recently and regretted that she did not receive timely and proper treatment for her femoral neck fracture. The original X-ray showed no displacement of the fracture end and mild insertion, but she was afraid of surgery and refused to receive percutaneous internal fixation treatment. The choice of treatment for femoral neck fracture depends on the patient’s general health, age, type of fracture, degree of displacement, and quality of bone. For femoral neck fractures in young people, even if there is a risk of femoral head necrosis, closed or incisional internal fixation should be the first choice of surgery, while for elderly patients there are more options available. The principles of treatment for elderly patients are: early surgery and early postoperative bed release. The aim is to effectively prevent complications such as pneumonia, decubitus ulcers, urinary tract infections, and deep vein thrombosis due to prolonged bed rest. In fact, it is often not the fracture itself that threatens the life of elderly patients, but the complications caused by long-term bed rest due to improper choice of treatment, or the aggravation of coexisting diseases that threaten the life safety of elderly patients. There are various treatment methods for femoral neck fractures in the elderly, including closed percutaneous hollow nail internal fixation, single head replacement, bipolar head replacement and total hip replacement. Specific patients should be treated on a case-by-case basis. In terms of fracture alone, we can choose 2-3 hollow nails for percutaneous internal fixation of femoral neck fracture in elderly people who have non-displaced fracture or insertion type fracture, or whose displacement is not large enough for successful closed reduction. In this approach, 2-3 small incisions of about 1 cm are made in the upper lateral thigh and performed under the guidance of a C- or G-arm imaging system. The procedure can be completed in 20-30 minutes with little injury, little bleeding, little interference with the patient’s internal organs, little interference with the residual blood flow of the femoral head, and the stability of the fracture end can be maintained. The purpose of percutaneous hollow nail internal fixation for embedded or nondisplaced femoral neck fractures is to provide a more reliable and safe stability for this type of fracture. This is because almost 100% of inserted fractures heal, whereas more than 15% can be displaced without internal fixation. Non-displaced femoral neck fractures have no stability due to the lack of insertion, and if internal fixation is not performed, almost all fractures can be displaced at any time, and if displacement occurs, the prognosis is greatly reduced. In elderly femoral neck fractures with large displacements, if anatomical or near-anatomical repositioning is not possible, simple internal fixation has no therapeutic significance and joint replacement should be preferred as the treatment. For elderly patients with little activity, single head replacement or bipolar head replacement can be chosen. If the doctor handling the patient is an experienced orthopedic surgeon and conditions permit (financial support, not an emergency), total hip replacement is an option to relieve pain and restore function with more assurance. However, for elderly patients with femoral neck fractures, the reasons for choosing total hip replacement are: 1. It allows the elderly patient to bear weight early and regain mobility, which helps prevent complications caused by bed rest and inactivity. 2. As an early treatment method, joint replacement eliminates the possibility of bone non-union and ischemic necrosis of the femoral head in femoral neck fractures. 3. Compared with other internal fixation, it can reduce the chance of reoperation. Among the seemingly small differences in treatment options for elderly femoral neck fractures, the selection of the most suitable treatment option for the patient varies from person to person, depending on the intended treatment goals of the patient and family, as well as the orthopedic surgeon’s proficiency and responsibility in the treatment method and the hospital’s equipment conditions.