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Factors influencing clinical outcomes of osteosynthesis for elderly patients with Garden stage I and II femoral neck fractures are not well understood.To determine the factors influencing the clinical outcomes of in situ osteosynthesis in non-displaced femoral neck fractures in the elderly, radiographs and clinical data of patients were retrospectively analyzed. The subjects were 49 patients with femoral neck fractures (Garden stages I and II), who underwent osteosynthesis, with correctly inserted screws and with more than 2 years of follow up. The relationships between preoperative anteroposterior X-ray parameters including Garden stage, the presence or absence of spikes, the Singh grade, the Garden alignment index, the degree of impaction at the fracture site (the capital impaction index) and postoperative outcomes were analyzed.Among the 49 cases, there were eight unsuccessfully treated patients, two with non-union and six with late segmental collapse. The “without spikes” fracture type (P < 0.05) and the degree of capital impaction when the capital impaction index (P < 0.0001) was greater than the mean plus the standard deviation, were significantly associated with unsuccessful outcomes.Excessive shortening at the fracture site on the anteroposterior radiograph in the femoral neck fracture of Garden stages I and II can be used to predict poor outcomes from in situ osteosynthesis.