Background: Femoral neck fracture is a challenging orthopedic injury and internal fixation is the best treatment option for young and middle-aged adults where joint preservation is crucial. Dynamic Hip Screw (DHS) fixation with an additional de-rotation screw has been introduced to improve rotational stability and enhance union rates, yet limited evidence exists in Bangladesh. Objective: To evaluate the fracture patterns, complications, radiological union and functional outcomes of adult patients with femoral neck fractures treated with DHS and de-rotation screw fixation in a tertiary care hospital in Bangladesh. Methods: This descriptive cross-sectional study was carried out in the Department of Orthopedic Surgery at Chattogram Medical College Hospital, over 18 months. A total of 60 adult patients (≥18 years) with unilateral femoral neck fractures treated with DHS and de-rotation screw fixation were included. Patients with pathological fractures, multiple injuries or prior hip surgery were excluded. All underwent standard DHS with de- rotation screw fixation under spinal anesthesia. Patients were followed up at 3rd, 6th, 9th, and 12th month. Outcomes were assessed using radiological union criteria and the Harris Hip Score (HHS). Data were analyzed by using SPSS (version 25). Ethical issues were maintained strictly at every stage of the study. Results: The mean (±SD) age of the patients was 34.7 (±11.3) years, with a male predominance (83.3%). Road traffic accidents were the leading cause of injury (66.7%) and basicervical fractures (B-3 type) were most common (63.3%). Non-union and hip stiffness were the most frequent complications (10.0%). By 12 months, 95.9% of patients were pain-free, 93.9% walked without a limp, and 98% achieved unaided mobility. All patients attained unlimited walking distance and full sitting comfort by final follow-up. Weight-bearing milestones improved progressively, with 64.3% bearing full weight at 6 weeks, 88.9% at 9 weeks, and 100% at 12 weeks. At one year, functional outcomes were excellent in 69.4%, good in 24.5%, and fair in 6.1%, with no poor outcomes. Conclusion: DHS with de-rotation screw fixation is an effective and reliable treatment for femoral neck fractures in young and middle-aged adults. It provides high union rates, favorable functional recovery and acceptable complication rates. Despite longer operative times this method offers best bio-mechanical stability and should be considered a preferred option in resource-limited settings such as Bangladesh.