Objective To evaluate the effect of femoral neck fracture treated by open reduction with direct anterior approach (DAA) and closed reduction and fixed by cannulated screws.Methods From December 2015 to December 2018, 46 patients with femoral neck fracture were treated with open reduction and 46 patients with closed reduction by cannulated screws. The age, sex, height, weight of patients, Garden type of the fracture, time from injury to operation, operation time were prospectively analyzed. The amount of bleeding, Garden reduction index, Harris functional score of hip on day one, 3,6, 12 and 24 months after operation were obseved. The nonunion rate of fracture and the incidence of avascular necrosis of femoral head (ANFH) were calculated. Spearman’s correlation analysis and Logistic multiple regression analysis were used to study the factors affecting ANFH after femoral neck fracture Results The amount of bleeding and operation time in open reduction group were greater than those in closed reduction group (P＜0.05), but Garden reduction index in open reduction group was better than that in closed reduction group (P=0.04). The Harris score of hip in open reduction group was better than that in closed reduction group at 6 months and 12 months after operation（P＜0.01;P=0.01）. Within 24 months after surgery, rate of ANFH in the open reduction group was significantly lower than that in the closed reduction group (P=0.01), and there was no statistical difference in the nonunion ratebetween the two groups (P=0.06). Spearman correlation analysis showed that there was a significant positive correlation between Garden classification of femoral neck fracture and the incidence of femoral head necrosis after femoral neck fracture (R=0.52, P＜0.001), but Logistic multiple regression analysis did not find relevant factors affecting the incidence of femoral head necrosis after femoral neck fracture.Conclusion The quality of open reduction and cannulated screw fixation via DAA approach is better than that of closed reduction and percutaneous minimally invasive cannulated screw fixation in the treatment of femoral neck fracture. The function of affected hip is better within 12 months after operation,and the incidence of avascular necrosis of femoral head is lower within 24 months after operation.