Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of femoral neck system (FNS) for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring in middle-aged and young adults. [Methods] A total of 21 young and middle-aged patients underwent abovesaid surgical treatment for femoral neck fractures. The patient was placed in oblique lateral position with the affected side elevated 40° with beanbag. The pin in supracondylar of the fractured side was inserted, and a fracture retractor frame was installed. As longitudinally traction was applied with adduction and internal rotation, the fracture was reduced properly under C-arm 3D image monitoring, a longitudinal incision 3 cm in length was made at the greater trochanteric of the femur to ex- pose the proximal femur. As the guide was placed on the lateral aspect the femur, guide pins were inserted. Finally, the FNS was installed to fix the fracture following the guide pins with the screw tips 5mm below the femoral head cartilage surface under image monitoring, and then the incision was closed in layers. [Results] All patients were successfully operated on with operation time of (54.2±11.3) min, intraoperative blood loss of (197.5±18.3) ml, and fluoroscopy time of (65.1±3.2) seconds. All the patients were followed up for (14.5±4.2) months, got prop- er fracture reduction with Garden index grade I in 16 cases and grade II in 5 cases, got fracture healing in (3.5±1.5) months and were marked in Harris score at the last follow-up of (84.5±4.2). [Conclusion] The FNS used for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring has advantages of improving the reduction, enhancing fixation stability and accuracy, and achieves satisfactory hip function recovery.