Purpose <p>Fibrous dysplasia is an uncommon disease with heterogeneous presentations and patterns of bone involvement. Lesions around the proximal femur are the most common. The article reviews the different surgical options described in the literature and summarizes recent recommendations in managing proximal femoral lesions.</p> Methods <p>A comprehensive review of the literature was conducted to analyze surgical techniques, including curettage with bone grafting, osteotomies for deformity correction, fixation methods for fractures, and total hip arthroplasty (THA).</p> Results <p>Curettage and bone grafting, while traditionally used, are largely discouraged due to high recurrence rates and limited efficacy. Osteotomies, particularly valgus intertrochanteric and subtrochanteric osteotomies, are effective for correcting deformities such as the Shepherd’s crook deformity, with intramedullary fixation currently being considered the gold standard. Fracture fixation remains individualized, with a range of implants, including intramedullary nails and fixed-angle devices, chosen according to the fracture pattern, localization of the lesion within the proximal femur and patient age. THA is a viable option for end-stage osteoarthritis as well as select cases of acute fractures, with cementless components, augmented by bone grafts when necessary, showing favorable results.</p> Conclusions <p>Surgical management of proximal femoral FD is multifaceted and tailored to individual patient presentations. Despite advancements, there is still no standardized approach, emphasizing the need for high-quality studies to establish consensus guidelines.</p>