【Abstract】Objective To study the clinical effect of Kocher-Langenbeck approach combined with limited Smith-Petersen approach in the treatment of Pipkin type IV fractures. Methods The clinical data of 11 patients with Pipkin type IV fracture treated in our hospital from January 2015 to January 2020 were analyzed retrospectively, of which 8 cases were followed up for a long time, 1 case lost follow-up after 1 year and 2 cases lost follow-up completely. All patients were male, aged from 16 to 59 years old, with an average of (37.4 ±15.39) years. Among them, 3 cases were complicated with sciatic nerve injury and 1 case was bilateral Pipkin IV fracture. The patients underwent operation from 3 to 7 days after admission, with an average of (4.56 ±1.24) days. The operation time and intraoperative bleeding were recorded. The patients were followed up from 13 months to 70 months with an average of (40.67 ±19.56) months. The degree of fracture reduction was evaluated according to Matta standard, heterotopic ossification grade was evaluated by Brooker classification, osteonecrosis of femoral head was evaluated by Ficat and Arlet grade, and hip joint function was evaluated by hip arthritis clinical severity score, Harris score and quality of life score，and the functional recovery was compared.Results The operation time of the patients ranged from 90 to 240 min (mean 137.78 ±41.77min), and the intraoperative bleeding was 150 ml to 500 ml, with an average of (311.11 ±113.96) ml; incision healing and no skin infection and necrosis. According to Matta criteria, the degree of postoperative X-ray and CT reduction was excellent in 8 cases and good in 1 case. To the last follow-up, there was no ectopic ossification and osteonecrosis of the femoral head in all cases. The clinical severity score of hip arthritis was mild in 1 case and moderate in 1 case. According to the modified Harris hip score standard: 8 cases were excellent and 1 case was good at the last follow-up.The functional scores of the patients at 3, 6, 12 months after surgery and the last follow-up were compared, and there was significant difference in the functional comparison within one year (according to the level of aversion 0.05, p < 0.05), but there was no significant difference in the functional comparison after one year (according to the level of aversion 0.05, p > 0.05). The scores of quality of life were good.Conclusion Kocher-Langenbeck approach combined with limited Smith-Petersen approach showed clear and effective reduction for pipkin type Ⅳ fractures. There was significant difference in functional recovery within 1 year, but there was no significant difference in functional recovery after 1 year, there was no increase in the occurrence of complications, and the overall quality of life was good.