Introduction: The anatomical complexity of the acetabulum and the difficulty of classifying fractures mean that treatment plans change continuously.

The decision to treat surgically involves evaluating the type of fracture, individual factors, the hospital’s possibilities and the surgeon’s experience.

Materials and methods: We carried out a retrospective review of 81 patients treated surgically for acetabular fractures between January 1994 and December 2003 with minimum follow-up of one year. 49 patients were followed up for more than 3 years. The patients’ ages were between 19 and 74. We reviewed the type of fracture, presence of dislocation, injury mechanism, associated sciatic injury, surgical approach and time to weight-bearing. We evaluated clinical (Merle d’Aubigne) and radiological results at one and three years.

Results: One patient required total hip replacement after a year and four at three years. According to the Merle d’Aubigne scale, there were 63 excellent results, 14 good and 4 fair at one year (81 cases), and 41 good and excellent, 6 fair and 2 poor at three years (49 cases).

There was one case of intraarticular screw, another with an incarcerated bone fragment and another of sub-capital fracture.

Conclusions: In treatment, careful classification is essential to choose the appropriate surgical approach and achieve better reduction.

Good reduction improves the functional prognosis. The worst outcomes were in elderly patients. In young patients the outcome was related to the damage to joint cartilage.