Abstract: [Objective] To compare the clinical efficacy of fixed femoral neck fracture in femoral neck system FNS group and cannulated screw (CS) CS group. [Methods] A retrospective analysis was performed for 50 cases of femoral neck fracture treated by internal fixation surgery in our hospital from February 2020 to February 2021. According to the results of preoperative communication, 25 cases were divided into FNS group and 25 cases in CS group, and perioperative data, follow-up data and imaging evaluation data of the two groups were statistically analyzed. [Results] Both groups successfully completed the surgery and were followed up. The operation time, intraoperative fluoroscopy, guide needle positioning and walking time of the FNS group were better than those of the CS group (P<0.05). The CS group had more advantages in terms of total incision length and intraoperative blood loss (P<0.05). There was no significant difference in length of hospital stay between the two groups (P>0.05). At postoperative follow-up, the FNS group had better postoperative complete weightbearing activity time and Harris score than CS group (P<0.05), and there was no significant difference in hip extension-flexion ROM and hip internal rotation-external rotation ROM at the same time point between the two groups (P>0.05). The Harris score, hip extension-flexion ROM, and hip internal rotation-external rotation ROM were significantly improved between the two groups compared with the preoperative period (P<0.05). In terms of image evaluation, there were no significant differences between the FNS group and the CS group in terms of Garden alignment index, neck trunk angle angle, and Tonnis hip degeneration grade (P>0.05), and there were no significant differences in neck trunk angle angle and Tonnis hip degeneration grade when comparing different time points in the group (P>0.05). However, there was a significant difference in the Garden alignment index before and after surgery (P<0.05). [Conclusion] In the treatment of femoral neck fracture, FNS has the advantages of short operation time, strong stability, good recovery of hip function, and fast fracture healing.