Anatomical Reduction Rate Increased, Fluoroscopy Frequency Reduced: The Clinical Efficacy of the Modified Reduction Sequence in the Treatment of Acetabular Both-Column Fractures

Background Hip acetabular fractures, especially complex both-column types, pose significant surgical challenges. Traditionally, the "anterior column first, posterior column second" reduction sequence has been widely adopted. However, a modified "posterior column first, anterior column second" sequence has been proposed to potentially improve surgical precision and outcomes. This study aimed to systematically compare the clinical efficacy and safety of these two reduction sequences in the surgical treatment of acetabular both-column fractures. Methods A retrospective analysis was conducted on 40 patients with acetabular both-column fractures treated between March 2023 and June 2025. Patients were divided into a modified group (n = 10), which underwent the "posterior column first, anterior column second" sequence, and a control group (n = 30), which received the traditional "anterior column first, posterior column second" sequence. Surgical parameters (operative time, fluoroscopy frequency, use of additional posterior approaches), fracture reduction quality (assessed via postoperative CT using the Matta criteria), early recovery (time to first ambulation), and hip function at 6 months (Merle d'Aubigné score) were compared. Results Baseline characteristics were comparable between groups ( P  > 0.05). The modified group showed a non-significant trend toward shorter operative time (239.3 ± 109.3 min vs. 311.3 ± 83.6 min; P  = 0.082) and earlier time to first ambulation (43.5 ± 3.5 days vs. 51.0 ± 15.2 days; P  = 0.068). Intraoperative fluoroscopy frequency was significantly lower in the modified group (16.4 ± 2.1 times vs. 31.1 ± 3.7 times; P  < 0.001). Although overall reduction quality distribution did not differ significantly ( P  = 0.053), the modified group had a higher anatomical reduction rate (80.0% vs. 43.3%) and no unsatisfactory reductions. At 6 months, the modified group had significantly better Merle d'Aubigné scores (17.8 ± 0.4 vs. 16.5 ± 1.3; P  = 0.001). Conclusions The modified "posterior column first" reduction sequence significantly reduces intraoperative radiation exposure and improves mid-term hip function in patients with acetabular both-column fractures. It also shows promising trends in shortening surgery time, increasing anatomical reduction rates, and facilitating earlier mobilization. These findings support the modified sequence as a safe and effective surgical strategy, particularly when the posterior column fragment is relatively intact. Further prospective, multicenter studies with larger samples are recommended to confirm these benefits and refine clinical indications.