For best results, surgery should take place within seven days of injury. The potential for difficulties and complications increases after three weeks.

Depending on the fracture pattern, one of three surgical approaches will be chosen which will give the best access for reconstruction of the acetabulum. These include the Kocher-Langenbeck approach (posterior approach), the Ilioinguinal approach (simultaneous access to both anterior & posterior portions of the pelvic ring), and the Extended iliofemoral approach (lateral approach). The patient is placed on a special operating table that applies traction to the leg during surgery and assists in reducing the fracture. (Figure 5).

Surgery to repair acetabulum fractures is called open reduction and internal fixation. Open refers to making an incision that exposes the broken bone fragments to view. Reduction refers to the process by which the surgeon uses specially designed instruments to grasp the bone fragments and manipulate them into their normal position. Internal fixation occurs when metal screws and plates are used to hold fractured bone fragments to the unbroken portions of the pelvis.

Screws and plates (thin strips of metal with holes to accommodate screws) fix fractured bone fragments together. Typically made of stainless steel, these implants do not react with body fluids or cause an allergic response. Implants made of vitallium or titanium are also safe and effective. (Figure 6 and Figure 7).