Two-column fracture of the left acetabulum following a bicycle accident in a 76-year-old male. Significant premorbidities included cardiomyopathy with s/p myocardial infarction nine years ago, recurrent DVTs with warfarin anticoagulation, lower limb atherosclerosis with s/p femoro-popliteal bypass, and s/p viral encephalitis with residual impaired gait and presence of suprapubic catheter. Due to s/p multiple abdominal surgeries, the anterior approach was no option. The individualized treatment plan was defined as ORIF via one singular Kocher-Langenbeck approach, aiming to convert the two-column fracture into a stable fracture pattern with secondary congruence of the hip joint. Computed tomography (CT) scans show the two-column fracture in frontal, axial views and 3D reconstruction (column A1–A3), postoperative conventional radiographs display the reduced joint line at two weeks (column B) and at three months follow-up (column C).