Objective To explore the operative therapy of young and middle-age patients with femoral collum fracture to improve the therapeatic efficacy. Methods 25 cases of femoral collum fracture were treated with opening and internal fixation, and circumflex iliac vascular pedicle bone graft of ilium with monitoring skin flap. After operation, The blood supply of femoral collum was observed by the monitoring skin flap. Results The blood supply of the monitoring skin flap in 23 cases was good, and in 2 cases the monitoring skin flap's color chang indicated that the crisis occurred in the circulation of the grafted bone. The grated bone recovered the blood supply through removing thrombosis by operation. All the patients were cured early, and no femoral head nercosis occured. Conclusion The transplantation of iliac lamella of circumflex ilium profound artery with monitoring skin flap for the treatment of femoral collum fracture could monitor the blood supply of femoral head, improve the fracture healing, and decrease the incidence of femoral head necrosis.