Femoral head fractures are usually associated with hip dislocations and the result of high-velocity trauma and should be managed in the emergency as per Advanced Trauma Life Support (ATLS) guidelines. A through history and examination prevents missing out on injuries elsewhere. Plain AP radiograph of the pelvis in the emergency confirms the diagnosis. An urgent closed reduction under sedation should be attempted in the ER in less than 6 h followed by a CT scan to plan for definitive management. If the patient requires open reduction, CT scan can be done prior to plan for simultaneous reduction and fixation of the femoral head fracture.