This study aimed to compare the efficacy of cannulated screw combined with medial femoral plate and simple cannulated screw for Pauwels type III femoral neck fracture. In May 2022, relavent clinical trial articles were searched in seven online databases. After literature screening, quality evaluation, and data extraction according to the specific inclusion and exclusion criteria, the differences in therapeutic efficacy, complications, and intraoperative outcomes were compared between the two groups. A total of nine articles were finally included in the meta-analysis. The qualities of the nine articles were medium. Although the results showed that cannulated screw combined with medial femoral plate prolonged the operation time and increased blood loss (p <0.05), it demonstrated better fracture reduction and Harris score, shorter healing time and less internal fixation failure than in the simple cannulated screw in the treatment of Pauwels type III fracture (p <0.05). The sensitivity analysis, Egger's test, and trial sequential analysis (TSA) showed that the combination results were stable and reliable. This demonstrated that compared to that with the simple cannulated screw, the cannulated screw combined with medial femoral plate had better efficacy and less complication. Key Words: Femoral neck fracture, Therapy effect, Cannulated screw, Medial femoral plate, Trial sequential analysis.