Abstract：[Objective] To compare the clinical outcomes of femoral neck system versus cannulated compression screws for femoral neck fracture in young and middle-aged patients through meta-analysis. [Methods] The electronic databases were searched before March 2022, including PubMed、Embase、Cochrane Library, Wanfang, CNKI, and VIP databases for published researches on FNS versus CCS for femoral neck fracture. RevMan 5.4 software was used to conduct meta-analysis of the data. [Results] A total of 10 articles were included. Among them, 324 patients used FNS; 374 patients used CCS. As results of this meta-analysis, The FNS group had better results than the CCS group in the fluoroscopy frequency, postoperative weight-bearing time, fracture healing time, femoral neck shortening length, and Harris score (P＜0.05). The CCS group had better results than the FNS group in the intraoperative blood loss and incision length (P＜0.05). In the FNS group，the rate of internal fixation failure and the rate of neck shortening length was significantly less than that in the CCS group（P＜0.05）. There were no significant differences in operation time, hospital stay，rate of nonunion and rate of avascular necrosis of the femoral head between the 2 groups (P＞0.05).[Conclusion] In the treatment of femoral neck fractures in young and the middle-aged patients, compared with CCS fixation, FNS group has earlier postoperative weight-bearing time and fracture healing time. It also can effectively prevent the shortening of femoral neck and internal fixation failure, which is beneficial for patients to recover the hip function ability.