This study compares surgical outcomes in femoral neck fractures, particularly focusing on Garden type III and IV fractures. It evaluates 200 patients treated with various methods, including screws with plates, hemiarthroplasty, and total hip arthroplasty. The majority of fractures were Garden III (39%) and IV (36.5%), with most patients being elderly women. Screw and plate fixation was used in 93 cases, showing a relatively low complication rate, with only 6.45% developing avascular necrosis. In contrast, arthroplasty groups had higher mortality rates, likely due to delayed surgery and postoperative immobility. The study concludes that screw and plate fixation can be an effective option, especially when early surgery and joint preservation are prioritized