Abstract Femoral head fractures are rare injuries. The Pipkin classification is a well-accepted system used to describe these fractures. Pelvic roentgenograms and a computerized tomography scan will provide the information necessary to classify and thereby develop a management plan for these injuries. Although there is general agreement regarding the treatment of associated fractures of the femoral neck and acetabulum, treatment of the femoral head fracture varies depending on the size and location of the fragment. Options range from closed reduction and traction for some nondisplaced fractures to arthrotomy with excision or open reduction and internal fixation of the femoral head fragment. Stabilization can be obtained using a variety of fixation devices. The hip joint may be approached anteriorly or posteriorly depending on the location of the femoral head fragment. The classification, treatment options, operative techniques, postoperative management, and potential complications associated with femoral head fractures are presented.