Femoral head fractures in adults are rare injuries typically associated with hip dislocations and high-energy trauma. Motor vehicle accidents are the most common cause. While plain radiographs are the first-line imaging modality, computed tomography is essential for detailed fracture assessment and surgical planning. The Pipkin classification is widely used in clinical practice. Treatment options include conservative and surgical approaches depending on fracture characteristics and associated injuries. This review summarizes current concepts in diagnosis and management of femoral head fractures in adults.