Objective To compare the effect of three different positioning methods in closed reduction and cannulated screw internal fixation of femoral neck fracture. Methods The data of 90 patients with femoral neck fracture from January 2018 to January 2021 were retrospectively analyzed，including 41 males and 49 females.The age ranged from 24 to 65 years，with an average of(47.7±3.6) years.According to different intraoperative positioning methods，they were divided into three groups：guided positioning group(30 cases，positioning with new three dimensional honeycomb Guide)，small incision positioning group(30 cases，exposure positioning of small incision on the outside of greater trochanter)，and unarmed positioning group(30 cases，percutaneous puncture and unarmed positioning).All patients underwent closed reduction and internal fixation with three cannulated screws.There was no significant difference in preoperative general data among the three groups(P＞0.05).The operation time，fluoroscopy times，needle puncture times，screw spacing，screw coverage area，parallelism between screws，fracture healing time and Harris function score of hip joint at the last follow-up were recorded.Results  All patients were followed up for 18~54 months，with an average of(34.9±5.9) months.There was no significant difference in fluoroscopy times，fracture healing time and Harris score at the last follow-up among the three groups(P＞0.05).The times of needle puncture and the deviation of parallelism between screws in the guide positioning group were less than those in the small incision positioning group and the unarmed positioning group.The operation time of small incision localization group was longer than that of guided localization group and free hand localization group.The screw spacing and screw coverage area of the guide positioning group were larger than those of the small incision positioning group and the free hand positioning group，and the small incision positioning group was larger than that of the free hand positioning group.The above differences were statistically significant(P＜0.05).Nonunion occurred in 2 cases in the small incision positioning group and 3 cases in the free hand positioning group.And the fractures of the remaining 85 patients healed.One case of femoral head necrosis occurred in the free hand positioning group.During the follow-up period，there were no complications such as infection，neurovascular injury，deep vein thrombosis，screw penetration，screw breakage and refracture.Conclusion The new three-dimensional honeycomb guide positioning method has significant advantages in small incision and unarmed positioning，which can effectively reduce puncture injury and improve the accuracy of positioning.