Purpose: The study is to review the results of intracapsular femoral neck fractures in young adults (age<65) treated with reduction and multiple-screw fixation from 2000 to 2007. Method: Sixty-four consecutive patients were reviewed retrospectively. The mean age of the patients at the time of injury was 53.5 (32–65) years old. All fractures were either closely or openly reduced and fixed with three 7.5-mm cancellous screws. The mean follow up period was 36.8 months (6–100). Results: We found that 9 of 64 (14.1%) patients developed osteonecrosis of femoral head on follow up. Displacement of fracture (Garden classification), initial stability of fracture pattern (Pauwel classification), and quality of reduction (Haidukewych grading) were found to have significant effect on the development of osteonecrosis, whereas the effect of patient age, time lapse of surgery, capsulotomy, hip aspiration, and postoperative weight bearing regimen were not statistically significant. Conclusion: Fracture pattern and quality of reduction govern the fate of the femoral heads in young adults with their intracapsular femoral neck fractures fixed with screws.