Femoral head fracture-dislocations, although uncommon, are associated with a high incidence of complications due to the complex anatomy and vascular supply of the hip joint. These injuries, frequently resulting from high-energy trauma, may lead to both acute and long-term morbidity. Avascular necrosis (AVN) of the femoral head is a predominant complication, particularly in Pipkin type III fractures, due to compromised blood flow. Heterotopic ossification (HO) is the most frequent complication, occurring in over 15% of cases, potentially causing pain, stiffness, or sciatic nerve compression. Sciatic nerve injury is observed in 4–10% of cases and may be traumatic or iatrogenic, with outcomes depending on the type and timing of intervention. Infection, though less common (1–3.2%), can lead to deep joint sepsis and preclude total hip arthroplasty. Recurrent instability and posttraumatic osteoarthritis contribute to long-term functional deterioration and pain. Malunion or nonunion of the femoral head or trochanteric flip osteotomy can result in joint incongruity and the need for secondary surgical intervention. Chronic pain and general deconditioning further impair recovery. Prompt identification, preventive strategies, and individualized management of these complications are crucial to optimize clinical outcomes and preserve joint function in this challenging injury pattern.