Intracapsular hip fractures are a common etiology presenting to orthopaedic surgeons. Patients are generally elderly with low bone mineral density and often have significant medical comorbidities. The unique anatomy and vascular supply of the femoral head lead to a high risk of avascular necrosis in patients who sustain intracapsular fractures. Management is almost exclusively operative and can broadly be divided into internal fixation and primary arthroplasty. Internal fixation is reserved for younger patients and those with non-displaced fractures. For older patients and those with displaced fractures, arthroplasty in the form of hemiarthroplasty or total hip arthroplasty is the standard of care. Multidisciplinary perioperative care and postoperative rehabilitation reduce mortality and improve functional outcomes in this complex patient population.