OBJECTIVE: To compare the efficacy of femoral reconstruction nailing and retrograde intramedullary nailing with hollow nailing in the treatment of femoral stem combined with ipsilateral femoral neck fractures and to discuss the respective indications for surgery. METHODS: According to the case selection criteria, 21 cases of femoral stem combined with ipsilateral femoral neck fractures were reviewed from January 2001 to May 2010, and 10 cases were fixed with femoral reconstruction nail and 11 cases were fixed with retrograde intramedullary nail with hollow nail. The differences in gender, age, combined injuries, fracture site, and fracture type between the two groups were not statistically significant (P > 0.05). Postoperative imaging and clinical functional follow-up was performed once a year at 1, 3, 6, 9, 12 and thereafter to assess fracture healing and complications by clinical and imaging, and to analyze and compare the relationship between fracture site and type and internal fixation method. RESULTS: Twenty-one patients were followed up for 12 to 48 months, with a mean of 27.1 months. There was no statistical significance between the two groups in terms of operative time, intraoperative bleeding, postoperative blood drainage, healing time of femoral stem and femoral neck fractures, and Friedman-Wyman functional assessment (P > 0.05). The hospitalization cost was statistically higher in the femoral reconstruction nailing group than in the retrograde intramedullary nailing plus hollow nailing group (t=16.71, P=0.016). The healing rates of femoral stem fracture (X2=0.005, P=0.943) and femoral neck fracture (X2=1.155, P=0.282) were not statistically significant in both groups. The femoral reconstruction nailing group was complicated by one case of atrophic femoral stem dysplasia, one case of nonunion of femoral neck fracture, and two cases of healing of rotational deformity. The retrograde intramedullary nail with hollow nail group was complicated by delayed healing of the femoral stem in 1 case, limb shortening in 3 cases, knee pain in 2 cases, and adhesion of the knee extension device in 1 case. Conclusion: The treatment of femoral stem fractures combined with femoral neck fractures should be individualized, and the femoral reconstruction nail is more suitable for femoral neck base fractures combined with narrow and near narrow femoral stem fractures, and retrograde intramedullary nail with hollow nail is more ideal for patients with head-down, difficult-to-reduce femoral neck fractures combined with distal femoral stem fractures or intra-articular knee injuries and periarticular fractures that require simultaneous management.