Intra-capsular fracture neck of femur in a young patient is a surgical emergency. Results of internal fixation with cannulated screws to date show high rates of non-union and of avascular necrosis. This leading to a high rate of re-operation with cannulated screws. A tendency therefore is to lean toward total arthroplasty of the hip in the instance of displaced fracture of the neck of femur.

We discuss both the biomechanical and biological reasons for failure of internal fixation of displaced fractures of the neck of femur with cannulated screws, and criteria required to provide adequate fixation of these fractures to allow union and avoid osteonecrosis.

We consider other methods of fixation of displaced intracapsular fractures and analyse illustrative cases demonstrating these methods.

In view of the precarious biological milieu of displaced intracapsular fractures of the neck of femur, we feel that the use of cannulated screws is a poor fixation method. Therefore the option of internal fixation should not be abandoned in favour of arthroplasty because of poor results from this one biologically and biomechanically inadequate operation.