Short-Term Functional Outcome of Posterior ORIF Combined with Antegrade Anterior Column Screw in Transverse-Based Acetabular Fractures

Background: Some Transverse-based acetabular fractures require posterior reduction and fixation. Adding an antegrade anterior column screw allows restoration of two-column stability through a single posterior approach, avoiding a second exposure.Patients and Methods: This prospective study included 21 skeletally mature patients. Eligible fractures included transverse, T-type, and transverse with posterior wall patterns requiring a posterior approach. All patients underwent fixation through a Kocher–Langenbeck approach combined with an antegrade anterior column screw. Reduction quality was assessed using Matta criteria, and functional outcomes were evaluated using the modified Merle d’Aubigné–Postel score at 3, 6, and 12 months. Predictors of the 12-month functional outcome were analyzed.Results: The median age was 29 years, with male predominance. Transverse with posterior wall fractures were the most common pattern (61.9%). Reduction was anatomical in 57.1%. The median Merle d’Aubigné–Postel score improved from 13.0 at 3 months to 16.0 at 6 and 12 months, with 80.9% of patients achieving excellent or good outcomes. arthritis occurred in 14.3% of cases. Age showed a significant negative correlation with the final functional score (p = 0.009). Reduction quality (p = 0.013) and surgeon experience (p = 0.042) were significant predictors.Conclusion: Posterior open reduction and internal fixation combined with an antegrade anterior column screw is a reliable single-approach technique for transverse-based acetabular fractures, providing stable fixation and favorable short-term functional outcomes.