In this episode, the hosts explore the challenging landscape of young femoral neck fractures, highlighting their high-energy mechanisms, complex morphology, and substantial risk of fixation failure. Drawing on a retrospective Edinburgh cohort, they note that one in four patients under 60 experienced complications—including loss of fixation, nonunion, or avascular necrosis—often leading to poorer long-term function and quality of life. The discussion emphasizes how younger, more active patients tolerate complications poorly, the technical demands of achieving anatomic reduction, and the influence of surgical expertise. The guests underline that outcomes must move beyond radiographs to include gait, mobility, and patient-reported function, especially as true RCTs remain unlikely due to the rarity of these injuries.