【Abstract】 ［Objective] To systematically evaluate the clinical efficacy of 4 cannulated screws (4CS) versus 3 cannulated screws (4CS) in the treatment of femoral neck fractures. ［Methods] PubMed, CNKI, Cochrane library, Wanfang, VIP database, Embase, CBM, and ChiCTR databases were searched for literature comparing 4CS and 3CS for femoral neck fractures from the time of database construction to January 2023. Quality assessment and data extraction were done by each of the 2 investigators independently, and meta-analysis was completed using RevMan 5.3 software. ［Results] Five publications with a total of 436 patients were included. RESULTS: 4CS for femoral neck fractures had more operative time (P < 0.05), intraoperative bleeding (P < 0.05), and intraoperative fluoroscopy (P < 0.05) than 3CS; however, 4CS was superior to 3CS in terms of 6-month postoperative Harris score (P < 0.05), fracture healing time (P < 0.05), fracture nonunion rate (P < 0.05), femoral head necrosis rate (P < 0.05), and nail retraction rate (P < 0.05) were better than those of 3CS; the differences in incision length (P > 0.05), time to walk on the ground (P > 0.05), and hospitalization days (P > 0.05) were not statistically significant between the two. ［Conclusion] 4CS for femoral neck fractures has the advantages of short fracture healing time for patients, low incidence of fracture non-union, high Harris score at 6 months postoperatively, and low dropout rate, with significant clinical results; however, 4CS requires longer operative time, more intraoperative bleeding, and more intraoperative fluoroscopy than 3CS.