Abstract : [Objective] To explore the short-term effectiveness of femoral neck system in treatment of Pauwels type Ⅲ femoral neck fractures. [Methods] A retrospective study was conducted on 23 patients Pauwels type Ⅲ for femoral neck fractures admitted from March 2020 to August 2020.All patients received femoral neck system internal fixation. Perioperative conditions, fracture reduction quality, fracture healing time, femoral neck shortening, postoperative complications, and Harris score were recorded. [Results] The operative time was 50～110 minutes with a mean of (66.93±13.12) minutes. The blood loss was 30～88 ml with a mean of (60.30±17.20) ml. The incision length was 5～8cm, with an average of (6.50±0.59)cm. The follow-up time was 14～20 months with an average of (17.22±1.55) months.22 patients healed in 3～6 months with a mean of (4.40±0.95) months,1 case was incompletely healed. As time changes, Harris score, extension-flexion ROM, and internal-external rotation ROM were significantly increased over time (P<0.05), Harris score at the last follow-up was 81.9～98, excellent and good rate was 100%.The overall Garden index of hip joint showed a decreasing trend, but there was no statistical difference (P>0.05).Femoral neck shortening was ≥5mm in 5 cases and > 10mm in 1 case, with a total shortening rate of 21.7%.No necrosis, infection, malunion or internal fixation loosening occurred in 23 patients. [Conclusion] Femoral neck system fixation of Pauwels type Ⅲ femoral neck fractures can significantly reduce postoperative complications and obtain satisfactory clinical results.