Articular cartilage lesions and osteochondral defects remain a difficult problem for the patient and physician. A variety of procedures and treatments have been proposed to lessen symptoms and restore the articular surface. The knee joint has been the focus of the vast majority of these cartilage restoration procedures. Osteochondral defects of the proximal femur are significantly less common, and their management remains poorly defined. This article reports the case of a young man with a deep osteochondral defect of the femoral head caused by penetrated resorbable screw after internal fixation of a displaced large single fragment of the posterior acetabular rim and subsequent treatment using mosaicplasty.