Femoral neck fractures in young adults below the age of 65 most often result from high-energy trauma, in contrast to the low-energy mechanisms more common in elderly patients. As a result, treatment goals in younger patients focus on preserving the femoral head’s blood supply, achieving anatomic reduction, and maintaining stable fixation to support long-term function. This article reviews the anatomy and biomechanics of the femoral neck, emphasizing the vascular supply and structural support that influence both surgical strategies, as well as risk of complications. Classification systems including Pauwels, Garden, and OTA are outlined to better understand how they can help treatment decisions. Principles of reduction are discussed, covering both closed and open techniques, along with considerations in implant placement and approach. Postoperative management, including protected weight-bearing, early rehabilitation, and monitoring for complications is discussed. Challenges such as avascular necrosis, nonunion, fixation failure, and femoral neck shortening remain significant concerns; strategies for prevention, management, and consistent monitoring are reviewed. The purpose of this article is to provide a practical framework for understanding and managing femoral neck fractures in young adults. By combining anatomical principles, classification systems, surgical techniques, and postoperative protocols, the article aims to equip readers with the knowledge necessary to optimize outcomes in young patients.