Patient had complete fracture of the R femoral neck with posterior rotation of the femoral head. Should have heightened suspicion in any elderly patient with hip pain even when there are negative radiographs. MRI or bone scan can be done to look for occult femoral neck fractures when suspicion is high. MRI is most sensitive at time of presentation. Age related bone loss is believed to be the most important factor in determining the incidence of femoral neck fractures. Fractures of the femoral neck occur primarily from low-energy injuries in the elderly and high-energy injuries in younger patients.