Among 82 patients still alive after osteosynthesis of femoral neck fractures between 1974 and 1983, 67 (i.e. 81.7%) were controlled clinically and radiologically. The average follow-up period was 57.0 months. The average age of 36 men was 45.3 years, the average age of 31 women was 56.1 years. Fractures were divided in lateral and medial femoral neck fractures, the medial fractures were classified according to Pauwels and Garden. The rate of avascular head necrosis mounted 20.7%, the rate of non union 13.8%. Both complications were dependent on the type of fracture. Besides reduction and impaction of fragments time of operation proved to be important: In 37 fractures type Garden III and IV the rate of avascular head necrosis was 3-fold higher after secondary osteosynthesis than after emergency operation at the day of accident. Our concept in treatment of femoral neck fractures is based on these factors: Emergency operation, decompressive capsulotomy, valgus reduction, impaction of the fragments and internal fixation to allow movement.