Femoral head fractures are rare but significant intra-articular and intracapsular fractures that often require emergent surgical management. Femoral head fractures can be classified using the Pipkin classification system and are commonly associated with posterior hip dislocations and high-energy mechanisms of injury. Care must be taken to assess preoperative radiographs and assess for presence of a hip dislocation, associated acetabular fractures, or femoral neck fractures, which all affect surgical approaches and management. Goals of surgical treatment focus on urgent closed reduction of the hip and then achieving an anatomic reduction of the articular surface, often through open reduction and internal fixation, with countersunk conventional screws, headless compression screws, or bioabsorbable fixation to minimize the risk of post-traumatic arthritis and osteonecrosis of the femoral head.