Femoral neck fractures are rare in young adults but carry high complication rates. Owing to the risk of prolonged loss of working capacity and permanent impairment of hip function, they rank among the challenging injuries in orthopedic traumatology. Unlike osteoporotic hip fractures in elderly patients, fractures in young patients are most often associated with high-energy trauma, axial loading, and polytrauma. Not every chronologically young patient should be assumed to be physiologically healthy. In fractures resulting from low-energy trauma, osteopenia, metabolic bone disease, chronic alcohol use, smoking, endocrine disorders, and medication use must be carefully investigated. The fundamental goals of treatment are to preserve the femoral head, achieve anatomic reduction, and obtain union through stable internal fixation. Management of these fractures is difficult because of their intracapsular location, the delicate vascular anatomy of the femoral head, and the adverse effects of synovial fluid on the fracture hematoma. Particularly in vertical fractures, nonunion, avascular necrosis, femoral neck shortening, and implant failure are frequently encountered due to the high shear forces involved. Current literature indicates that, although timing is important, the quality of reduction and the selection of a biomechanically appropriate implant are more decisive in determining outcomes. In this review, the epidemiology, biomechanics, classification, diagnostic methods, conservative treatment, closed and open reduction, cannulated screws, Dynamic Hip Screw, fixed-angle implants, the femoral neck system, medial buttress plating, arthroplasty, valgus osteotomy, and complication management of femoral neck fractures in young patients are evaluated in detail in light of the current literature.