Objective To research the influence of five kinds of spatial distributions of hollow screws on the fixation effect of femoral neck fracture. Methods Geometric models of femoral neck fracture with Pauwels type I, II and III were built by reverse engineering according to the CT images of femur. Based on the finite element analysis software ANSYS, the stress distributions of hollow screws, head side and stem side of femoral neck and the displacement distribution of the model were obtained for different fixation methods. Results For femoral neck fracture with Pauwels type I, II and III, the maximum stresses at the head side of femoral neck are the inverted triangle fixation method, two screws parallel fixation method, two screws parallel fixation method, respectively. The maximum stresses at the stem side of femoral neck are the inverted triangle fixation method, inverted triangle fixation method and two screws parallel fixation method, respectively. The minimum stresses on the screws are all the cross fixation method. The minimum displacements of the model are double-supported fixation method, cross fixation method and double-supported fixation method. Conclusion The probability of deformation and fracture of the screw in cross fixation method is the smallest. Inverted triangle fixation method can provide a good mechanical environment for fracture area. For femoral neck fracture with Pauwels type I and III, double-supported fixation method has the strongest ability to prevent femoral neck shortening. While for femoral neck fracture with Pauwels type II, cross fixation method has the strongest ability to prevent femoral neck shortening.