Femoral head fractures are consequential but uncommon injuries. Because of their relatively rare occurrence, large series with validated outcomes have not been published, to our knowledge. However, the available literature provides important insights into the treatment of these challenging fractures. Understanding the anatomy, injury mechanism, and principles of treatment are essential for providing sound care and maximizing the chance of a good outcome. The osseous anatomy and supporting soft tissues of the hip create an inherently stable articulation. The femoral head is deeply seated within the acetabulum; the surrounding fibrocartilaginous labrum further contributes to stability. The capsuloligamentous structures (iliofemoral, ischiofemoral, and pubofemoral ligaments) are also important stabilizers of the hip. The intra-osseous and extra-osseous blood supply of the femoral head can be disrupted following a fracture-dislocation of, or during an operative approach to, the hip. The primary intra-osseous blood supply to the weight-bearing surface of the femoral head is from the deep branch of the medial femoral circumflex artery1-3. The medial femoral circumflex artery has two major branches, the superior and inferior retinacular arteries, although reports of the constancy of inferior retinacular branches vary2,4. The medial epiphyseal artery usually supplies the perifoveal region of the head1, and contributions from the …