Due to a low energy fall a 84-year-old female patient presented with a Pipkin-IV fracture. The femoral head and the acetabular rim were fractured, the patient presented with a dislocation of the hip. Due to atrial fibrillation permanent anticoagulation with warfarin was present. Following bridging, the individualized treatment included acute total hip replacement (THR) with a Müller acetabular reinforcement ring.