Thirty-four patients with acetabular fractures involving the quadrilateral plate were randomized to receive either supra-pectineal quadrilateral buttress plating (n=17) or infra-pectineal plating (n=17). The primary outcomes of interest were residual medial wall displacement, radiological outcomes (via the Matta score), and clinical outcomes (via the modified Merle d’Aubigné & Postel score). Secondary outcomes included operative time, intraoperative blood loss, complications, displacement, and the need for reoperation. Outcomes were assessed at multiple intervals up to 12 months. Overall, the results revealed no significant differences in radiological or clinical outcomes between groups, but the supra-pectineal group had a significantly shorter operative time and less blood loss. This suggests anatomical QLP offers similar efficacy to infra-pectineal plating, with lower procedural morbidity.