Acetabular fractures are intra-articular fractures and exhibit a bimodal age distribution, arising from high-energy trauma in younger patients and low-energy osteoporotic mechanisms in older patients. In recent years, a marked increase has been observed in the frequency of complex fracture patterns involving the anterior column and quadrilateral surface; this is leading to a growing clinical importance of anterior surgical approaches. The aim of this review is to evaluate the anterior approaches used in the surgical treatment of acetabular fractures – including the ilioinguinal, modified Stoppa and pararectus approaches, as well as percutaneous and endoscopic methods – in terms of their indications, surgical techniques, advantages and limitations. The ilioinguinal approach, first described by Letournel in 1961, is a technique that provides access to the anterior aspect of the broad acetabulum via three windows. However, it has certain limitations, including restricted visualisation and access to the quadrilateral surface, as well as the need for dissection of neurovascular structures. The modified Stoppa approach offers direct access to the quadrilateral surface via retropubic intrapelvic access; compared to the ilioinguinal approach, it provides a shorter operative time, less blood loss and higher rates of anatomical reduction. The pararectus approach, developed by Keel in 2012, offers access to both the suprapectineal and infrapectineal regions via five windows through a single incision, whilst providing the advantages of a shorter operative time and a smaller incision compared to the ilioinguinal approach. Although percutaneous and endoscopic techniques represent promising minimally invasive alternatives in selected patient groups, the level of evidence in the current literature remains limited. Therefore, the choice between percutaneous and endoscopic techniques should be made taking into account the fracture pattern, the surgeon’s experience and patient characteristics.