Acetabular fractures are complex intra-articular injuries involving the weight-bearing surface of the hip joint and require careful surgical planning. The posterior approach is an important surgical option, particularly for posterior wall, posterior column, combined posterior column-wall fractures, and selected transverse or T-type fractures with a dominant posterior component. The Kocher–Langenbeck approach remains one of the most commonly used posterior approaches, as it provides direct access to the posterior column, posterior wall, and retroacetabular surface. However, the success of this approach depends not only on the surgical field it provides, but also on accurate interpretation of fracture morphology, appropriate patient positioning, protection of the sciatic nerve, and careful management of the short external rotators and posterior capsule. In posterior wall fractures, recognition of intra-articular fragments, marginal impaction, and femoral head cartilage injury is essential, whereas in posterior column fractures, direct control of column reduction is a key determinant of surgical outcome. In selected cases in which the standard Kocher–Langenbeck approach is insufficient, extensile options such as trochanteric osteotomy, the modified Gibson approach, or surgical hip dislocation may be required. This review discusses the indications, surgical anatomy, technical steps, reduction and fixation principles, and complication prevention strategies of the posterior approach in acetabular fracture surgery.