Purpose: To investigate the effectiveness of open reduction and cannulated screw fixation via direct anterior approach (DAA) for the treatment of femoral neck fractures in young adults. Methods: The data from 43 young patients with irreducible femoral neck fractures who underwent this procedure from January 2013 to December 2017 were retrospectively analyzed. Garden's alignment index was measured after the operation and at the final follow-up to determine the reduction quality, and the Harris score was recorded at the final follow-up to assess hip function. Results: The average follow-up duration was 19 months (range, 12-31 months). Implant failure was observed in 3 cases and was associated with femoral neck shortening, and nonunion occurred in 2 patients. A total of 6 patients Exhibited features of avascular necrosis (AVN), four of whom (Ficat grade III) underwent total hip arthroplasty and two of whom (Ficat grade II) were asymptomatic at the final follow-up. There were no statistically significant differences in Garden's alignment index, as measured on X-ray radiographs, immediately after surgery and at the final follow-up. At the final follow-up, the mean Harris score was 82.41±14.06. The Harris score was considered excellent for 17 cases, good for 13 cases, fair for 3 cases, and poor for 4 cases. The rate of excellent and good outcomes was 81.1%. Conclusions: For cases of irreducible femoral neck fractures, open reduction and cannulated screw fixation via DAA can yield relatively good clinical outcomes.