A 40 years old man, was injured in a car accident as a front passenger, occurred during a frontal collision with another vehicle passing illegally in continuous white line down the center of a national road, the impact speed was 100 km per hour. Unfortunately, the patient was not restrained by seatbelt and sustained lower extremity and head impacts without loss of consciousness, he experienced a severe pain in his hips. On presentation to the emergency department, patient was hemodynamically stable and conscious, examination of the chest and abdomen was normal. However, both hips were deformed in flexion, internal rotation and adduction (Fig. 1), without neurovascular deficit or skin lesions of the lower limbs. Radiographs displayed bilateral posterior hip dislocation combined with right femoral head fracture, and small posterior wall fracture of the left acetabulum. (Fig. 2) Prompt hips reduction was performed within one hour of presentation through closed manipulation below general anesthesia, curarisation and controlled by fluoroscopy, patient was maintained in supine position on the ground and the aide applied a hand pression on the iliac wings of the pelvis, while the operator exerted a traction on the leg then flexed the hip with adduction and external rotation, the same technique was applied successfully to the second hip. The Left hip was stable up to 100  flexion and 45  internal and external rotation after reduction. However, the right hip was unstable, for this reason, we have positioned a posterior knee splint for temporary stabilization. Reduction of each hip was checked by antero-posterior pelvic radiograph (Fig. 3) and CT-scan (Fig. 4). X-ray showed an irreducible right femoral head fracture, but in the other side it showed a concentric reduction of the left hip joint. CT scan showed in the right side a one-third of femoral head suprafoveal fracture Pipkin type II that was anterior, rotated and incarcerated associated with two small fragments; one was superior and the second inferior. In the left side we have detected a minor posterior wall fracture of the left acetabulum without any intra-articular fragments. Surgical treatment was planned next day to accomplish anatomic open reduction of the right femoral head fracture and its internal fixation (ORIF) using a modified Hardinge approach that was chosen because the Pipkin II fragment was switched, therefore its reduction need surgical dislocation of the hip and a wide access to the femoral head. Moreover, this approach is known to have less risk of sciatic nerve injury, preserve the pelvitrochanteric muscles and have less risk of limping in comparison with the conventional Hardinge approach, because we spread the fibers of the gluteus medius just at its anterior middle one-third, preserving a great portion of this muscle insertions and function. In the operational room, under general anesthesia the patient was placed in the full lateral position with pubic and sacral support, left leg was maintained in extension to stabilize ipsilateral hip, then a modified external approach of Hardinge was performed exposing the fascia lata that was incised in line with skin incision and retracted anteriorly while the gluteus maximus was retracted posteriorly to expose the common tendon of vastus lateralis and the gluteus medius, it was split longitudinally at the anterior third and sharply separated from the greater trochanter. Without extension more than 3 cm proximally to the insertion of the great trochanter to avoid inferior branch of the superior gluteal nerve injury. An anterior flap was formed by the anterior portion of the gluteus medius, the underlying gluteus minimus, and the anterior portion of the vastus lateralis. A T-shaped capsulotomy was performed to release the anterior capsule. The hip joint was then dislocated, and the femoral head fracture was exposed, we have explored a rotated pipkin II fragment and extracted two small parts that had footprints in the not weight bearing area in the distal part of the femoral head (Fig. 5). After cleaning and washing hip joint, we have reduced the Pipkin fragment and fixed them by two small pins that was over-drilled with a cannulated drill bit, followed by osteosynthesis with two Herbert screws, then hip was reduced and the flaps was repaired by transosseuses sutures to the great trochanter layer by layer using a vicryl number 2. Postoperative examination revealed no neurological deficit and the postoperative imaging of the pelvis showed an anatomic reduction of the femoral head fracture and a good position of the two Herbert screws (Fig. 6). The patient was kept on bed rest for three weeks, followed by a further six weeks of right non-weight bearing. At 6 months there was a good fracture healing, the patient had no limited hip motion, without limping and normal return to his daily activity (Fig. 7). Then at one and two years follow up there was no signs of osteoarthritis or avascular necrosis detected on the pelvic X-rays. However, a right hip non-bridging Brooker type I heterotopic ossification was noticed (Fig. 8).