Objective To evaluate the efficacy of femoral neck system (FNS) and cannulated screw (CS) in the treatment of femoral neck fracture in adults during perioperative and conjunctional periods.

Methods By searching CNKI, Wanfang, VIP, CBM, PubMed, Embase and Cochrane databases, relevant literatures on the efficacy comparison of the two internal fixation regimens were collected. Review Manager 5.3 software was used to conduct a meta-analysis of the literature finally included in the study.

Results A total of 24 retrospective cohort studies were included in this study, with a total of 1 661 participants, including 783 participants in the FNS group (FNS treatment) and 878 participants in the CS group (CS treatment). In the FNS group, intraoperative fluoroscopy times (MD=-9.69, 95%CI, -11.27 to -8.11, P < 0.01), complete weight-bearing time (MD=-1.69, 95%CI, -2.88 to -0.50, P < 0.01), fracture healing time (MD=-1.15, 95%CI, -1.57 to -0.73, P < 0.01), Harris score at last follow-up (MD=-1.5, 95%CI, 2.30 to 4.59, P < 0.01) and femoral head necrosis rate (OR=0.48, 95%CI, 0.26 to 0.91, P=0.02) were superior in the CS group; however, intraoperative blood loss (MD=17.72, 95%CI, 9.88 to 25.55, P < 0.01) and incision length (MD=0.39, 95%CI, 0.04 to 0.73, P=0.03) in the FNS group were higher than those in the CS group. There were no significant differences between the two groups in terms of operation time (MD=-3.78, 95%CI, -7.95 to 0.39, P=0.08) and total hospitalization days (RR=-0.14, 95%CI, -0.43 to 0.14, P=0.32).

Conclusion FNS in the treatment of adult femoral neck fractures has the advantages of less intraoperative fluoroscopy, earlier complete weight-bearing time, faster fracture healing and higher hip Harris score, but compared with CS, it has more intraoperative blood loss and larger incision area.