Femoral head fractures are uncommon. This makes interpretation of the appropriate treatment methods difficult. The treatment is often dictated by associated injuries like concomitant femoral neck and acetabular fractures. Surgical approaches vary, and the optimal one is debatable among surgeons. Regardless of the surgical approach used, the protection of the femoral head blood supply is critical. Optimal treatment is also debatable, and multiple factors should be considered when trying to decide to fix, excise, or replace fragments. Historically, these fractures have yielded relatively poor results; however, recent literature utilizing newer surgical techniques and fixation methods has improved the overall outcome and recovery.