<p>This narrative review synthesizes the latest advancements in the diagnosis and management of proximal femoral osteochondromas, underscoring the complexities of surgical intervention near neurovascular structures and the importance of precise imaging techniques. Key challenges include managing hereditary multiple exostoses, which necessitate multiple interventions and careful monitoring for malignant transformation. The review advocates for a balanced approach to treatment, weighing the risks of surgery against potential complications from non-intervention, particularly in pediatric patients whose growth may be affected. Emerging surgical techniques and imaging technologies offer promising pathways to improve patient outcomes and reduce recurrence rates.</p>