Abstract Background Various epidemiological studies have revealed that the incidence of acetabular fracture is increasing rapidly. The most critical step in the treatment of displaced acetabular fracture is the anatomical reduction of the articular surface and stable fixation as well as the use of appropriate surgical approach to achieve good clinical outcomes. Aim of the Work to perform a systematic review to compare between modified Stoppa approach and ilioinguinal approach regarding Blood loss, Operative time and Complications in pelvi-acetablar fractures Patients and Methods On June 2022, we systematically searched the PubMed, the Web of Science, and the Cochrane Library electronic databases for relevant articles. The following terms were used for our search: acetabular fracture, approach and (comparison or versus Stoppa Approach, Ilioinguinal Approach, Pelvic fractures, Acetabular fractures and Pelvi- Acetabular Fractures.). We also checked the reference lists in the retrieved articles in order to include additional studies that met the criteria but had not been identified by the electronic search. All studies identified were individually assessed for inclusion in our study. Results That operative time was significantly shorter with the MS approach than with the IL approach and this was statistically significant. The main result of our results was post operative outcome was significantly better with the MS approach than the IL approach. In our study, there was no significant difference between the two approaches as regards postoperative complications except in nerve injury. Conclusion Our findings reveal that both the Modified Stoppa Approach and the Ilioinguinal Approach are viable options for the surgical management of pelvi-acetabular fractures. The choice between these two approaches should be tailored to individual patient factors, specific fracture patterns, and surgeon expertise. While the Modified Stoppa Approach may be associated with a lower incidence of certain complications, such as neurovascular injuries, the Ilioinguinal Approach provides better access to specific fracture types and may be favored in cases of associated anterior column or anterior wall involvement. Additionally, functional outcomes and long-term patient satisfaction appear to be comparable between the two approaches.