Objective To explore the effect of improved surgical method of intramedullary fibular allograft together with cannulated screw fixation combined with blood-activating and stasis-resolving Chinese medicine on the quality of life (QOL) of young and middle-aged fresh femoral neck fractures at intermediate stage. Methods A retrospective analysis was carried out in the articular orthopedics department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. The study involved 80 cases of young and middle-aged fresh femoral neck fractures receiving intramedullary fibular allograft together with cannulated screw fixation, and 50 qualified cases receiving cannulated screw fixation alone ( control group) . After the operation, all of the patients were given oral use of blood-activating and stasis-resolving Chinese medicine. After the last follow-up, Harris hip scoring, SF-36 scoring and radiographic evaluation were performed for the evaluation of clinical efficacy. Results The clinical application of intramedullary fibular allograft together with cannulated screw fixation combined with Chinese medicine was fulfilled in 80 hips of 80 cases. The follow-up period ranged from 48 to 84 months, averaging 62.68 ± 12.43 months. The improved surgical method group had an excellent and good rate of 93.75%, presented excellent-grade Harris scores and SF-36 scores, and had higher QOL scores than the control group (P<0.05) . After treatment, the two groups had statistically significant differences in the scores of SF-36 items of physical function ( PF) , bodily pain ( BP) , mental health ( MH) , vitality ( VT) , and general health ( GH) ( P<0.05 or P<0.01) , and also had significant differences in Harris scoring of pain, function and daily activities as well as the joint range-of-motion ( P<0.05 or P<0.01) . Conclusion The improved surgical method of intramedullary fibular allograft together with cannulated screw fixation combined with blood-activating and stasis-resolving Chinese medicine shows satisfactory therapeutic effect for young and middle-aged fresh femoral neck fractures at intermediate stages, which has the advantages of lower collapse rate after femoral head necrosis, less joint replacement, higher scores of the quality of life and Harris scoring, and better radiographic indicators than cannulated screw fixation alone.