Acetabular fractures occur in a bimodal age distribution with elderly patients generally sustaining fractures from low energy mechanisms and young patients from high energy mechanisms. The specific fracture pattern is determined by the position of the hip and force vector at time of impact. Associated injuries are common, including head, chest, abdominal, genitourinary, spine, and extremity injuries, as well as peripheral nerve injuries. While some fracture patterns may be amenable to conservative management, many others require operative intervention. Surgical decision-making is complex with indications, operative approach, and method of fixation dependent on fracture pattern, stability, degree of soft tissue injury, and patient factors.