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Fractures of the posterior wall of the acetabulum are the most common type of acetabular fracture, accounting for approximately 25% of all acetabular fractures. The simple appearance of the posterior wall fracture on plain radiographs underestimates its potential complexity. Rather than having one simple fracture fragment, most posterior wall fractures are comminuted or have areas where the articular surface along the margin of the primary fracture line is impacted into the underlying cancellous bone. In general, posterior wall fractures are amenable to nonsurgical treatment if the remaining, intact part of the acetabulum is large enough to maintain hip joint stability and congruity; however, this situation is often difficult to determine. Clinical outcome has been shown to be directly related to the accuracy of reduction, but accurate repositioning of all of the small posterior wall fragments is frequently a challenging task. This article reviews the etiology, clinical presentation, and the technique and results of open reduction and internal fixation of posterior wall fractures of the acetabulum.