Background: Major and unstable pelvic fractures as ipsilateral fractures of the femur and acetabulum are likely to cause severe pain and shock. Poly trauma management proceeds in line with ATLS protocol and Patients may require lifesaving surgeries. The study aimed to assess outcome of open reduction and internal fixation of psilateral fracture of acetabulum and fracture femur through one approach as the effect way of treatment. Patients and methods: A prospective study included 18 patients were presented with posterior wall acetabular fracture with ipsilateral femoral fracture. Patients admitted Orthopedic surgery Department of Zagazig University hospitals for fracture surgical fixations. Full history, clinical examination and radiological assessment and Majeed Score were performed for all patients. Follow up X rays were done in the 1st day postoperative, after two weeks, 3months , 6 months. Results: the healing time of femoral fracture ranged from 14 weeks up to 33 weeks with mean of 21.78 ± 5.9 and healing time of acetabular fracture was 17.22 ± 4.1 weeks. 55.6% of studied group gave excellent Majeed score of hip function, while only 16.7% were fair. Conclusion: Ipsilateral fractures of the femur and acetabulum treated simultaneousness using Kocher-Langenbeck approach did not demonstrate an increased risk of wound complications, and not contraindicated to antegrade femoral nailing.