Femoral head fractures, though rare, are high-energy trauma often associated with posterior hip dislocations and dashboard pattern of injury. These injuries demand precise diagnosis and tailored management due to their complex nature and high rates of complications, including reoperations. Historically traced back to the nineteenth century, the understanding and classification of femoral head fractures have evolved significantly. Pipkin’s classification, introduced in 1957, remains the most widely used, categorizing fractures by their relationship to the fovea centralis. However, newer classification systems like Brumback, AO/OTA, and Chiron classifications have added dimensions of dislocation direction, associated injuries, and fragment size. Despite these advances, no universal system comprehensively addresses all clinical and prognostic aspects, particularly joint stability and surgical decision-making. This chapter examines mechanisms of injury, reviews classification systems, and emphasizes their clinical relevance, providing an essential guide for the systematic evaluation and management of these challenging injuries.