Abstract: Objective: To investigate the hollow lag screw fixation and the artificial joint replacement in the treatment of femoral neck fractures. Methods: The hollow screw fixation in 35 patients, and femoral head replacement or total hip arthroplasty in 22 patients were reviewed. Results: There was no significant difference in the incidence of complication and reoperation rate, time to get out of bed and long-term functional score between the two groups (P>0.05). The hospitalization time, the expenses, operation time, surgical trauma and blood loss in the fixation group were significantly less than those in the hip replacement group (P<0.001). Conclusions: The effective internal fixation still is effective in treatment of fresh femoral neck fracture.