[Objective] To evaluate the clinical outcomes of pararectus approach for open reduction and internal fixation (ORIF) with internal iliosciatic plate for complex acetabular fractures involving the posterior column. [Methods] From January 2017 to December 2018, 16 patients received ORIF with internal iliosciatic plate for complex acetabular fractures involving the posterior column through the pararec- tus approach. The clinical and imaging results were evaluated. [Results] All the 16 patients had ORIF performed successfully without inju- ries to the abdominal organ, blood vessel or nerve, while with the operation time of (195.3±43.7) min and the blood loss of (710.4±232.8) ml. All the patients were followed up for (16.9±3.9) months on average. Compared with those at 3 months after operation, the Merle d 'Au- bigne score, Harris score, internal-external rotation range of motion (ROM) and flexion-extension ROM significantly increased at the last follow-up (P＜0.05) . Compared with that 3 months after surgery, the Tonnis grade for hip degeneration deteriorated at the latest follow-up, whereas which was not statistically significant (P＞0.05) . All the patients got fractures healed well at last follow-up. [Conclusion] This para- rectus approach for open reduction and internal fixation with internal iliosciatic plate does achieve satisfactory clinical consequences for complex acetabular fractures involving the posterior column.