【Abstract】Objective: to compare the difference in efficacy between the treatment of posterior wall and posterior column fractures of the acetabulum using direct posterior approach (DPA) and Kocher-Langenbeck approach (K-L). METHODS: Forty-three patients with fractures of the posterior wall and posterior column of the acetabulum treated with open reduction and internal fixation from January 2015 to June 2022 were retrospectively analyzed; 19 cases were treated with DPA approach and 24 cases with K-L approach. Perioperative data, follow-up and imaging results were compared between the two groups. RESULTS: Comparison of operation time, number of fluoroscopy, incision length, intraoperative blood loss, and time to start walking postoperative between the two groups, the DPA group was smaller than the KL group, with a significant difference of P＜0.05; There were no significant differences in hospitalization time, blood transfusion, and Grade A incision healing rate between the two groups, P > 0.05；there was one case of sciatic nerve injury in the DPA group and one case of superficial infection of the incision in the KL group in the postoperative period, and there were no significant differences in early postoperative period. There was no significant difference between the complication rates of the two groups (P > 0.05). All patients were followed up for a mean of (15.4±1.3) months. The postoperative full weight-bearing activity time in the DPA group was smaller than that in the KL group, P < 0.05; the postoperative VAS pain scores, Harris scores, and hip extension-flexion mobility in the DPA group were significantly better than those in the KL group at 1 and 6 months (P < 0.05); and the Harris scores, hip extension-flexion mobility, and Merle D'Aubigné-Postel scores at the last follow-up, hip internal-external rotation mobility were P > 0.05 in both groups, with no significant difference. There was no delayed fracture connection, re-displacement, infection, or loosening of internal fixation during the follow-up. Comparison of postoperative Matta score fracture reduction excellence rate, fracture healing time between the two groups, and Tonnis hip degeneration rating at the last follow-up were all P>0.05, with no significant difference; all patients' fractures healed within 16 weeks. There were 2 cases of heterotopic ossification and 2 cases of traumatic hip arthritis in the KL group after surgery, and there were no cases of heterotopic ossification and traumatic hip arthritis in the DPA group, P＞0.05, no statistical difference. CONCLUSION: The useing of DPA approach for the treatment of posterior column and posterior wall fracture of acetabulum has the advantages of less bleeding, shorter incision, fewer complications, satisfactory fracture reduction, good recovery of hip joint function after surgery compared with the K-L approach, and the near-term therapeutic effect is satisfactory.