INTRODUCTION AND IMPORTANCE: Femoral neck stress fractures (FNSFs) are rare injuries, particularly in middle-aged recreational runners, and pose significant diagnostic challenges. Despite their low incidence, early detection and appropriate management are crucial to prevent serious complications such as displacement or avascular necrosis. CASE PRESENTATION: A 52-year-old male runner presented with progressive right hip pain, exacerbated by activity and relieved by rest. Initial X-ray imaging was normal
however, MRI revealed an undisplaced transcervical femoral neck stress fracture, classified as Type II (compression-side). The patient underwent insitu fixation with cannulated screws. DISCUSSION: FNSFs present diagnostic challenges due to their subtle symptoms and low initial X-ray sensitivity. MRI remains the gold standard for early diagnosis. This case underscores the importance of clinical suspicion and early imaging in preventing complications like fracture displacement and avascular necrosis. CONCLUSION: Early recognition and timely intervention are critical in managing femoral neck stress fractures. MRI is essential for accurate diagnosis, and proactive surgical treatment effectively prevents severe complications, leading to favorable recovery outcomes. This case emphasizes the need for heightened clinical awareness in patients with unexplained hip pain to ensure optimal management.