Objective To compare the effects of surgical versus non-surgical treatment for femoral neck fractures in elderly patients, in order to provide guidance on treatment options. Methods The clinical effects and complications of different approaches from 42 patients with femoral neck fractures who had received treatment at our department from February 2006 to August 2011 were retrospectively analyzed. Results Of the 42 cases, 13 cases were treated with artificial hip replacement, 18 cases with hollow lag screw fixation, and 11 cases with tibial traction. No death occurred in patients treated with surgery, and 4 patients who had received non-surgical treatment died within 6 months of the followed-up. Conclusions Very elderly patients with femoral neck fractures generally perform well under appropriate perioperative care. Surgical treatment can produce good therapeutic effects, shorten the time for bed rest, improve the quality of life and reduce the mortality rate. Key words: Femoral neck fractures; Treatment outame