To report the results of a combined anterior and posterior approach to complex acetabular fractures and establish the guidelines for the operative treatment of complex acetabular fractures.

Thirteen fractures (8 both column, 5 T-shaped fractures) of thirteen patients (8 men, 5 women) were treated with this combined anterior and posterior approach from August 1995 to December 1999. We reviewed the clinical and radiological results for an average of 33months (range, 12-60) follow-up.

This approach resulted in an anatomical reduction in ten (78%) patients and, two imperfect and one poor reduction. The average Harris hip score was 69.2 (range, 58-87) and the clinical results were good in eleven, very good in one and poor in one patient using the D'Aubigne/Postel clinical grading. A poor reduction occurred in one patient who had a both column fracture that extended to the ipsilateral sacroiliac joint combined with a joint subluxation.

Overall clinical results for most complex acetabular fractures treated by a combined anterior and posterior approach were preferable to other approaches, but we must consider an extensile or extended ilioinguinal approach to be an alternative surgical approach in this complicated fracture that involves the sacroiliac joint.