This review paper on femoral neck fractures in the elderly provides updated information from the most recent literature and examines the advantages and disadvantages of different surgical treatment options. Femoral neck fractures are a common injury that many orthopaedic surgeons will encounter within their practice. These injuries are associated with significant morbidity, and the economic impact of surgically fixing these fractures is notable. Contemporary treatment options include internal fixation, hemiarthroplasty, and total hip arthroplasty. For non-displaced fractures, both internal fixation and hemiarthroplasty remain feasible options. Hemiarthroplasty decreases re-operation rate, while internal fixation decreases operative time, blood loss, and infection risk. Newly designed fixation constructs require further investigation. For displaced fractures, the literature strongly supports arthroplasty. Most elderly patients with displaced femoral neck fractures should be managed with a hemiarthroplasty. In select active elderly patients, total hip arthroplasty may achieve favourable early functional outcomes as compared to a hemiarthroplasty. Finally, cemented arthroplasty decreases periprosthetic fracture risk as compared to cementless arthroplasty. However, experienced arthroplasty surgeons with significant expertise in press-fitting techniques may achieve similar outcomes with cementless arthroplasty.