Journal of the American Academy of Orthopaedic Surgeons December 2007, Volume 15, Issue 12 Fracture of the Femoral Head Copyright © 2007 by the American Academy of Orthopaedic Surgeons. Kurt P. Droll, MD, Henry Broekhuyse, MD and Peter OBrien, MD, FRCSC Dr. Droll is Clinical Fellow, Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, BC, Canada. Dr. Broekhuyse is Clinical Associate Professor, Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver. Dr. OBrien is Associate Professor, Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Droll, Dr. Broekhuyse, and Dr. OBrien. Reprint requests: Dr. OBrien, Vancouver General Hospital, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9. Fracture of the femoral head is a severe, relatively uncommon injury; typically, it occurs following traumatic posterior dislocation of the hip joint. The Pipkin classification is the most commonly used classification system. Diagnosis is aided by a complete history, physical examination, and imaging, including computed tomography. Treatment consists of urgent closed reduction of the dislocated hip followed by nonsurgical or surgical management of any associated fractures. Controversies include the preferred surgical approach (anterior versus posterior) and whether to perform femoral head fragment excision or internal fixation. Complications associated with fracture of the femoral head and subsequent treatment include osteonecrosis, posttraumatic osteoarthritis, and heterotopic ossification. Fracture of the femoral head has been associated with a relatively poor functional outcome.