Management of hip osteonecrosis in the young is challenging, and femoral head preservation surgery is often preferred. We report the first local case of treating advanced hip osteonecrosis with a vascularised fibular graft in a 26-year-old man who presented with left hip pain after a fall. He was diagnosed with left hip osteonecrosis and underwent core decompression and insertion of a vascularised fibular graft. Postoperative radiographs and computed tomography of the hip were performed to assess viability of the graft. In this report, we discuss the technical considerations when operating on Asian patients and how technical difficulties are circumvented. We also report the postoperative outcome and discuss the various methods for monitoring viability of the graft.