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Abstract Background Osteochondromas are the most common benign bone tumors occurring near the end of long bones. In this case report, we demonstrate the successful treatment of a proximal femoral osteochondroma in a pediatric patient excised through a dual medial and anterior approach with no hip dislocation. Case presentation We present the case of a white Arab 14-year-old boy with chronic hip pain and inability to ambulate. He failed conservative treatment and was referred to us after X-rays revealed two osseous masses. He was diagnosed with an intra-articular hip osteochondroma confirmed on magnetic resonance imaging and computed tomography scan. He was treated surgically with excision using two incisions: Smith-Petersen approach and Ferguson approach. Conclusion This case presents the successful resection of a symptomatic pediatric proximal femoral osteochondroma, using dual medial and anterior approaches without the need for hip dislocation. This was optimal for both the safety and accessibility of this unusual condition.