Objective:To investigate the short-term efficacy difference between femoral neck system and cannulated compression screw in the treatment of femoral neck fracture in young and middle-aged patients.Methods:Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang, VIP and CBM databases were searched. All literature on the treatment of femoral neck fractures using the femoral neck system (FNS) or cannulated compression screw (CCS). RevMan 5.4.1 software was used to analyze data.Results:Twelve high-quality cohort studies were included, including 787 patients treated surgically for femoral neck fractures, of whom 369 were treated with FNS and 418 with CCS. Results of meta-analysis showed that FNS had shorter operative time than CCS for femoral neck fracture [ WMD=-8.09, 95% CI (-14.12, -2.06), P=0.009]. FNS had less intraoperative blood loss [ WMD=6.63, 95% CI (1.42, 11.83), P=0.010], Partial weight-bearing time of FNS was earlier postoperative [ WMD=-2.11, 95% CI (-3.00, -1.22), P<0.001], while full weight-bearing time was also earlier postoperative [ WMD=1.01, 95% CI (1.59, 0.43), P<0.001), The postoperative fracture healing time of FNS was shorter [ SMD=0.67, 95% CI (1.04, 0.30), P<0.001]. The Harris score of FNS at the last follow-up was higher [ WMD=4.67, 95% CI (3.26, 6.08), P<0.001]. The number of fluoroscopy during FNS was less [ WMD=-9.05, 95% CI (-10.92, -7.18), P<0.001]. The rate of severe femoral neck shortening after FNS was lower [ RR=0.36, 95% CI (0.19, 0.70), P=0.002]. The incidence of postoperative complications after FNS, including urinary tract infection, venous thromboembolism, bone nonunion, screw loosening, femoral head avascular necrosis, was lower [ RR=0.38, 95% CI (0.27, 0.53), P<0.001]. There was no difference in postoperative hospital stay between FNS and CCS [ WMD=0.01, 95% CI (-0.36, 0.39), P=0.950]. There was no difference in fracture reduction quality (Garden I) [ RR=1.04, 95% CI (0.87, 1.24), P=0.660]. There was no difference in fracture reduction quality (Garden II) [ RR=0.91, 95% CI (0.59, 1.39), P=0.650]. There was no difference in postoperative moderate femoral neck shortening [ RR=0.85, 95% CI (0.58, 1.26), P=0.430]. Conclusion:Compared with cannulated compression screw, femoral neck system had shorter operation time, less intraoperative blood loss, earlier postoperative part load or full load time, shorter fracture healing time higher Harris score at the last follow-up, less number of intraoperative fluoroscopy, and lower rate of severe femoral neck shortening. Besides, FNS had a lower incidence of postoperative complications including urinary tract infection, venous thromboembolism, bone nonunion, screw loosening, and avascular necrosis of femoral head than CCS.