Single versus double column fixation in transverse acetabular fractures: a randomized controlled trial

Objective: Transverse acetabular fractures (TAFs) account for roughly 25–30% of acetabular injuries and may occur either with or without associated posterior wall (PW) involvement. Achieving anatomical reduction is essential for optimal outcomes, yet recent efforts aim to minimize surgical invasiveness. Emerging studies have suggested that posterior column fixation (PCF) via a single approach may be sufficient. This investigationaims to compare the radiological and clinical outcomes of single-column versus double-column fixation (DCF) in TAFs, with particular focus on residual displacement, maintenance of reduction, and complication rates. Methods: This prospective randomized controlled trial was conducted over a two-year period at Ainshams University Hospitals. Thirty adult cases presenting with transverse or transverse–posterior wall fractures (TPWF) were randomly stratifiedinto two groups: Group A (n=15) received single-column posterior plating, while Group B (n=15) underwent DCF through combined posterior and anterior approaches. Clinical outcomes were assessed at two years using the modified Merle d’Aubigné and Postel (MDP) score, and radiographic reduction was evaluated according to the Matta criteria. Results: At 2-year follow-up, no statistically significant differences were found between groups in clinical scores (p=0.699) or radiological reduction outcomes (p=0.710). Immediate postoperative imaging likewise showed no meaningful variation (p=0.516). By contrast, Group B required significantly longer operative time and sustained greater blood loss (both p<0.001). Complication rates remained similar (33.4% vs. 40%; p=0.705). Conclusion: Single- and double-column fixation yield comparable clinical and radiological outcomes in TAFs. Nevertheless, PCF alone offers the advantages of shorter operative time and reduced blood loss, making it a viable option when adequate indirect anterior column reduction can be obtained.