Objective:To compare the efficacy of 2 fixation modes [dynamic hip screw (DHS) plus anti-rotation screw versus 3 cannulated compression screws (CCS)] in the treatment of femoral neck fractures complicated with comminuted posterior wall.Methods:The data were analyzed retrospectively of the 109 patients who had been treated for femoral neck fractures complicated with comminuted posterior wall at Department of Orthopaedics, Shenzhen Hospital, University of Chinese Academy of Sciences from February 2017 to December 2019. They were divided into 2 groups according to 2 fixation modes. There were 42 males and 16 females with an age of 48.5 (40.0, 55.3) years in CCS group of 58 cases subjected to fixation with 3 CCSs; there were 31 males and 20 females with an age of 47.0 (38.0, 53.0) years in DHS group of 51 cases subjected to fixation with DHS plus anti-rotation screw. The length of incision, operation time, intraoperative bleeding, weight-bearing time for the affected limb, visual analog scale (VAS), hip Harris score, and incidence of postoperative complications were compared between the 2 groups.Results:The comparison of preoperative general data between the 2 groups was not statistically significant, showing comparability between groups ( P>0.05). In the CCS group, the incision length [3.0 (2.9, 4.5) cm] and operation time [90.0 (73.8, 125.0) min] were significantly shorter than those in the DHS group [10.0 (9.0, 12.0) cm and 135.0 (110.0, 165.0) min], the intraoperative bleeding [40.0 (10.0, 100.0) mL] was significantly less than that in the DHS group [200.0 (150.0, 300.0) mL], the partial and complete weight-bearing durations of the affected limb [12.0 (12.0, 13.0) weeks and 24.0 (21.0, 25.0) weeks] were significantly longer than those in the DHS group [11.0 (10.0, 12.0) weeks and 19.0 (18.0, 20.0) weeks], and the perioperative VAS pain score [2.0 (2.0, 3.0) points] was significantly lower than that in the DHS group [5.0 (4.0, 6.0) points], but the incidence of follow-up complications [56.9% (33/58)] was significantly higher than that in the DHS group [33.3% (17/51)] (all P<0.05). There was no significant difference between the DHS group and the CCS group in the excellent and good rate of Harris hip score at one year after operation [94.1% (48/51) versus 91.4% (53/58)] ( P>0.05). Conclusions:In the treatment of femoral neck fractures complicated with comminuted posterior wall, DHS plus anti-rotation screw and 3 CCSs can both result in fine therapeutic outcomes but a relatively high incidence of complications at late follow-up. However, the former fixation mode can shorten the weight-bearing time for the affected limb and reduce complications but is more invasive than the latter fixation mode.