Posterior dislocation of the hip joint with a concurrent femoral head and neck fracture is a rare injury typically resulting from high-energy trauma. These injuries often end up with a poor outcome despite the potential for surgical reconstruction. Such injuries are most commonly observed in young adults, with the “dashboard injury” during vehicular collisions being the usual mechanism. The femoral neck fracture is believed to result from the continued transmission of force, with the femoral head fracturing first. Accurate diagnosis requires imaging studies such as X-rays and CT scans to delineate the exact injury pattern. Closed reduction is often challenging due to the displacement of femoral head fragments. Therefore, early open reduction and internal fixation are recommended. The Gibson or Kocher-Langenbeck approach, combined with a flip osteotomy of the trochanteric area, provides optimal access to the injury. The femoral head fragments are assembled and secured using interfragmentary screws, followed by retrograde screw fixation of the femoral neck. Once the reconstruction is complete, the hip dislocation can be reduced. However, the sequence of reconstruction and reduction may be altered if required to facilitate the procedure. Given the universally poor outcomes associated with this injury, even with successful reconstruction, primary arthroplasty is often favored, especially for elderly patients or those unwilling to risk a second surgery. Postoperative follow-up is crucial to monitor for complications, including non-union, osteonecrosis of the femoral head, heterotopic ossification, traumatic osteoarthritis, and stiffness. Early mobilization is encouraged to prevent hip stiffness and promote functional recovery.