1108 patients with low-energy femoral neck fractures were randomized to internal fixation with a sliding hip screw or cancellous screws. The objective of this study was to compare the rates of re-operation, complications (avascular necrosis, nonunion, implant failure, and infection), and health-related quality of life between the two methods of internal fixation over a 24-month follow-up period. The results of this trial indicated that the rate of re-operation did not significantly differ between sliding hip screws and cancellous screws. Subgroup analysis indicated favourable results with sliding hip screws for displaced fracture, fractures at the base of the femoral neck, and in patients who were current smokers. Avascular necrosis (AVN) occurred significantly more frequently in the sliding hip screw group. Nonetheless, the increased rate of AVN was not associated with significantly poorer outcome in health-related quality of life. As such, the results from this large randomized trial indicate that the choice of internal fixation method used for low-energy femoral neck fractures should be left to the discretion of the operating surgeon.