Central fracture dislocation of the hip with associated fracture of the femoral neck is rare. Treatment of choice consists of open reduction of the displacement and internal fixation of both fractures. Nevertheless, inadequate reduction of the burst fracture of the acetabulum may lead to hip arthritis, and the surgical approach to the femoral neck jeopardizes its vitality. In elderly patients early full motion and prompt physical rehabilitation can be achieved by total hip arthroplasty after fusion of the displaced femoral head to the acetabular wall.