BACKGROUND This injury has not been reported previously in the thoracic spine. All previous open fracture dislocations of the spine have been reported in the lumbosacral spine with three posterior and two anterior dislocations. OBJECTIVE To describe the treatment of an open thoracic fracture dislocation with primary open reduction, posterior stabilization, and fusion. METHODS Case report. METHODS A 25-year-old male pedestrian was struck by a car sustaining an open fracture dislocation of T8 on T9 with complete transection of the spinal cord. The accident resulted in complete paralysis of both lower extremities, a paraspinal hematoma from T4 to T12, and bilateral pneumothoracies. After wound irrigation and debridement, an open posterior reduction and stabilization was completed. The wound was closed primarily. RESULTS Two years after surgery, there was a solid fusion and no evidence of infection. The patient has persistent paralysis of both lower extremities. CONCLUSIONS Open thoracic spinal fracture dislocations can be effectively treated with primary open reduction and fusion with instrumentation.