Femoral head fractures are rare but complex injuries often resulting from high-energy trauma and frequently associated with hip dislocation and acetabular fractures. Due to their low incidence, treatment recommendations are largely based on limited clinical data, small case series, and expert opinion. This chapter explores recent advances in the classification, diagnosis, and management of femoral head fractures. Traditional systems like Pipkin remain widely used, though newer systems such as Chiron and AO aim to enhance reproducibility and prognostic accuracy. Advances in imaging, particularly 3D CT and CT angiography, have improved preoperative planning and vascular assessment. The evolution of surgical techniques includes improved exposure through surgical hip dislocation, minimally invasive fixation approaches, and selective use of arthroscopy for fragment management. Biodegradable screw fixation has emerged as a viable alternative to metal implants, reducing long-term complications. Treatment remains individualized based on fracture type, patient age, and risk of avascular necrosis. While ORIF is preferred in younger patients, total hip arthroplasty is increasingly considered for complex fractures (Pipkin III) and in the elderly population. Despite these advances, the evidence base remains limited, highlighting the need for multicenter studies and long-term outcome data to guide standardized care.