Abstract:[Objective] To compare the clinical efficacy of femoral neck system (FNS) versus cannulated screws (CS) for fixation of fem- oral neck fracture. [Methods] A retrospective study was performed on 50 patients who received internal fixation for femoral neck fractures in our hospital from February 2020 to February 2021. According to preoperative doctor-patient communication, 25 patients had the frac- tures fixed by FNS, while the other 25 patients were by CS. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were operated on successfully without serious complications. The FNS group proved signifi- cantly superior to the CS group in terms of operation time [(45.1±7.0) min vs (51.8±8.7) min, P＜0.05], intraoperative fluoroscopy times [(8.8± 1.8) vs (15.5±2.4), P＜0.05], guide pin placement times [(3.4±0.9) vs (8.8±1.5), P＜0.05] and postoperative walking time [(4.0±1.2) weeks vs (6.2±1.1) weeks, P＜0.05], despite of the fact that the former was significantly greater than the latter in terms of total incision length [(4.5± 0.5) cm vs (3.5±0.5) cm, P＜0.05] and intraoperative blood loss [(84.6±21.1) ml vs (43.2±8.7) ml, P＜0.05]. The FNS group resumed full weight-bearing activity significantly earlier than the CS group [(11.1±1.2) weeks vs (13.5±1.5) weeks, P＜0.05]. The Harris score, hip exten- sion-flexion ROM and hip internal- rotation rotation ROM significantly increased over time in both groups (P＜0.05). The FNS group was significantly better than the CS group in Harris score at 1 month, 3 months postoperatively and at the latest follow-up [(55.2±3.2) vs (46.8± 2.8), P＜0.05; (80.8±3.4) vs (78.4±1.9), P＜0.05; (89.8±2.6) vs (87.6±2.6), P＜0.05], although there were no significant differences in exten- sion-flexion ROM and internal rotation-external ROM between the two groups at any corresponding time points (P＞0.05). Regarding to im- aging, Garden alignment index significantly improved in both groups immediately after surgery and at the last follow-up compared with that before operation (P＜0.05). However, the neck-shaft angle and Tonnis classification for hip degeneration remained unchanged remarkably in both groups postoperatively (P＞0.05). There were no significant differences in the abovementioned image items between the two groups at any time points accordingly (P＞0.05). [Conclusion] The FNS has the advantages of short operation time, strong fixation stability and good hip function recovery over the CS in the treatment of femoral neck fractures.