A fifteen-year-and-four-month-old male stumbled late in the evening while running over uneven ground and felt his right leg give away. He was unable to bear weight on the right lower extremity after falling. He was transferred from a referring facility overnight with a shortened, externally rotated right lower extremity and his distal neurovascular exam was intact. Body mass index was 24.4. The patient used albuterol as needed for asthma and seasonal allergies and had an otherwise unremarkable medical history. He reported no prodromal right hip pain. Radiographs and computed tomography (CT) of the pelvis and right femur () showed a posteriorly dislocated Delbet type Ib right capital femoral epiphyseal separation and a fracture of the right acetabulum through the triradiate cartilage, posterior column, and posterior wall. Three-dimensional CT reconstruction images are shown in. Closed reduction of the fracture-dislocation was not attempted in the emergency department due to the concern of further disruption of the blood supply to the capital femoral epiphysis. The patient was taken urgently to the operating room on the day of presentation by a pediatric orthopaedist (R.C.) for closed manipulation and reduction using axial traction. Given the low energy mechanism and resultant posteroinferiorly displaced capital femoral epiphyseal fracture-separation, and the absence of any epiphyseal fragments remaining attached to the distal femoral neck fracture fragment, the displaced physeal fracture-separation was closed reduced with minimal manipulation. The reduced capital epiphysis was percutaneously stabilized with two 6.5 mm cannulated screws (). The femoral head was noted to remain posteriorly subluxated due to the posterior column acetabular fracture, prompting placement of a distal femoral skeletal traction pin. The patient then returned to the operating room on hospital day two for open reduction and internal fixation of the right acetabulum () via a Kocher-Langenbeck approach under the direction of an orthopaedic traumatologist (D.E.A.) using a 1-hole spring plate, two 3.5 mm reconstruction plate, and 3.5 mm bicortical position screws. The patient was instructed to be nonweight-bearing on the right lower extremity for eight weeks postoperatively and to follow posterior hip precautions. He was given six weeks of chemoprophylaxis for venous thromboembolism with low molecular weight heparin and for heterotopic ossification with indomethacin. He was able to ambulate with physical therapy on the day following surgery while remaining nonweight-bearing on the right lower extremity. At the two-month follow-up, he was no longer following weight-bearing restrictions and he and his mother reported no pain or functional deficit. Radiographs () revealed maintenance of fixation with concentric reduction of the right femoral head and maintenance of reduction of the displaced capital femoral epiphysis. In an eighteen-month follow-up visit conducted via telephone due to coronavirus pandemic restrictions, the patient's mother reported he had no mobility restrictions and only occasional right hip pain. At an in-person follow-up visit 22 months postoperatively, the patient reported one day of groin pain approximately 13 months postoperatively and no other symptoms. On examination, he maintained a well-compensated posture in sagittal and coronal planes, ambulated with an unremarkable gait, and demonstrated grade 5/5 strength in all lower extremity muscle groups. His right hip range of motion was 0-140° flexion, 45° external rotation, and 30° internal rotation without discomfort. He lacked 5° external and internal rotation compared to the left lower extremity. Radiographs () revealed a healed right acetabulum and right proximal femur with interval physeal closure, preserved joint space, concentrically reduced spherical femoral head, and no evidence of avascular necrosis, confirmed upon review by our institutional board-certified musculoskeletal radiologist. Both 6.5 mm partially threaded screws in the femoral neck were broken at the base of the threads, and the proximal femoral physeal separation had healed with a slight varus malunion. The patient had resumed all activities including sporting activities such as playing basketball. He will return for reevaluation at 36 months postoperatively.