Objective To compare the clinical efficacy of medial buttress plate combined with cannulated compression screw and simple cannulated compression screw in the treatment of Pauwels Ⅲ femoral neck fracture.Methods Retrospective analysis of 72 patients of Pauwels III femoral neck fractures treated in our hospital from January 2015 to June 2021.It is divided into two groups according to the internal fixation method, group A (n = 39) was treated with three cannulated compression screws; group B (n = 33) was treated with medial buttress plate combined with three cannulated compression screws. Compare the perspective times, surgical incision length, operation time, the amount of intraoperative blood loss,postoperative fracture healing, postoperative complications and postoperative hip function Harris Score . Results All Patients were followed up for 12-24 months, The operative time, intraoperative blood loss, in Group A patients were lower than in Group B (P <0. 05), There was no significant difference in operation perspective times and incision length between the two groups (P> 0. 05).The deformity healing rate, nonunion rate and healing time in Group A were higher than Group B (P <0. 05).There was no ectopic ossification in the two groups . The postoperative Harris score of Group A in January was lower than in Group B (p>0.05); The Harris score of Group A in March, June and December was lower than in Group B (P <0.05).Conclusion: The medial buttress plate combined with cannulated compression screw has certain advantages compared with simple three cannulated compression screws in the treatment of Pauwels Ⅲ femoral neck fracture. It can shorten healing time, reduce nonunion and deformity healing rate, and is beneficial to the recovery of hip function.