ObjectiveTo examine the imaging evidence of the use of percutaneous compression plate (PCCP) in promoting femoral neck fracture healing compared with cannulated screws (CS).MethodsThis retrospective study enrolled patients with femoral neck fractures undergoing internal fixation procedures. The patients were divided into a PCCP group and a CS group with imaging as the primary outcome and Harris hip score (HHS) as the secondary outcome.ResultsThis study included 162 patients: 80 in the PCCP group and 82 in the CS group. There were no significant differences between the patients in their preoperative baseline characteristics. Patient follow-up ranged from 24–56 months (mean 30.7 months). Differences in reduction quality, screw slipping, neck shortening and avascular necrosis (AVN) were not significant between the two groups. There were significant differences between the treatment groups in bone absorption, nonunion, healing time, screw withdrawal and fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12 months were significantly better for the PCCP group than the CS group, but the differences were not significant at 24 months and last follow-up.ConclusionStable internal fixation with dynamic compression was the key to PCCP promoting femoral neck fracture healing.