[Objective] To evaluate the clinical outcome of cannulated screw combined with medial buttress plate (CSBP) for internalfixation of Pauwels type III femoral neck fractures. [Methods] A retrospective study was conducted on 72 patients who received open reduc-tion and internal fixation (ORIF) for Pauwels type Ⅲ femoral neck fractures from January 2015 to June 2021. According to the results ofpreoperative doctor- patient communication, 33 patients underwent CSBP, while the remaining 39 patients had conventional cannulatedscrew (CS) performed. The documents regarding perioperative period, follow-up and radiographs were compared between the two groups.[Results] All patients in both groups had corresponding surgical procedures performed smoothly without serious complications. Althoughthe CSBP group consumed significantly longer operation time, associated with significantly more intraoperative blood loss than the CS group(P＜0.05) , there were no significant differences between the two groups in terms of the total incision length, intraoperative fluoroscopytimes, guide needle placing times, ambulation time, incision healing, and hospital stay between the two groups (P＞0.05) . All patients werefollowed up for 12~24 months, and the CSBP group returned to full weight- bearing activity significantly earlier than the CS group (P＜0.05) . In the CSBP group, there was no bone nonunion or femoral head necrosis. Among the 39 cases in the CS group, there were 3 cases ofbone nonunion and 2 cases of femoral head necrosis. The incidence of late complications in the CSBP group was significantly lower thanthat in the CS group (P＜0.05) . The Harris score, hip extension -flexion range of motion (ROM) , and hip internal-external rotation ROM in-creased significantly over time postoperatively in both groups (P＜0.05) . The CSBP group proved significantly superior to the CS group interms of Harris score, hip extension- flexion ROM, and hip internal-external rotation ROM at all time points postoperatively (P＜0.05) .With respect of radiographic evaluation, the CSBP group was significantly superior to the the CS group in terms of Garden index, neckshaft angle, and Tonnis grade for hip degeneration at the latest follow-up (P＜0.05) . [Conclusion] This cannulated screw combined with me-dial buttress plate for internal fixation of Pauwels type Ⅲ femoral neck fractures does achieve considerably better clinical outcomes than the cannulated screw only.