The chapter provides a comprehensive overview of anterior surgical approaches for femoral head fractures, including their evaluation, surgical anatomy, indication, advantages, and complications. The evolution of the anterior approach traces back to Carl Hueter in 1881, with significant refinements by Smith-Petersen and others, who made substantial improvements that led to the current changes that maximize results and reduce complications. The anterior approach has become more popular in managing femoral head fractures, particularly Pipkin type I and II, due to its direct access to anteroinferior fractures and minimal disruption to surrounding structures. This approach offers a direct, minimally invasive pathway, adhering to internervous planes to reduce neurovascular risk and avoid muscle detachment. Using T-shaped capsulotomies for the best exposure and lateralizing the incision to protect the lateral femoral cutaneous nerve are important changes. Comparative studies highlight superior outcomes with anterior approaches in Pipkin I and II fractures, with reduced surgical time, blood loss, and postoperative pain compared to posterior or surgical dislocation techniques. However, complications like heterotopic ossification and avascular necrosis remain concerns. Advances such as the modified Hueter approach mitigate these risks, offering better visualization and preserving future arthroplasty options. This chapter underscores the anterior approach’s pivotal role in the effective management of anterior femoral head fractures, presenting a thorough exploration of its evolution, anatomy, techniques, and outcomes.