Both column fractures of acetabulum are the complete disruption of the pelvic ring resulting from high-energy injuries and are commonly associated with multiple traumas including other systemic problems. Although the femoral head freely floating over the acetabulum due to pseudo-congruency of the femoroacetabular joint is considered, it was shown that the anatomy was greatly disrupted with the medialization of the femoral head covered with the increased depth of acetabulum. Excluding unusual problems making surgical treatment impossible, open reduction with plate-screw fixation should be performed. In majority, there are three main fragments. The only difference from the T-type fractures is that the transverse fracture line is located superior to the acetabulum. One single extended exposure such as iliofemoral or triradiat is required to access to all fracture fragments, however it is associated with high rates of surgical wounds and complications. Instead, stepwise anterior or posterior exposures may be performed within single or consecutive steps. Ilioinguinal approach is preferred in the presence of the major displacement in the anterior column, while Kocher-Langenbeck exposure is preferred in the presence of the major displacement in the posterior column. The fixation should be performed using sacroiliac joint, a keystone for the fixation, and both columns should be placed onto it. Both columns should be fixed with 3.5 mm reconstruction plates. If adequate reduction of the other column is achieved after the reduction of the operated column, anterior or posterior column screws may be alternatively used to fix the other column. Long-term outcomes are high enough in the presence of achieving successful results and smooth joint space. Even if arthrosis is found in the long-term followup, medial placement of both columns may technically facilitate arthroplasty.