We reviewed the epidemiology and complications of 79 patients who had operative treatment for an acetabular fracture undertaken at this hospital, in the first 5 years of a pelvic and acetabular fracture service. The median Injury Severity Score was 18 (range, 9-41). Sixty-five patients (82%) had an important injury of at least one other system. Eighteen patients (23%) had a sciatic nerve injury on presentation. Thirty-seven patients (47%) had a post-operative complication, but this did not affect the outcome in the majority. The re-operation rate was 5%.Seventy-four patients (94%) had clinical and radiological follow-up for a mean of 2.6 years. Fifty-five patients (74%) had a good or excellent result, which was associated with early operation and an anatomical reduction. Poor outcome was associated with delay to surgery, failure to achieve or maintain reduction, and femoral head damage at the time of injury.