In this retrospective study, 27 acetabular fractures treated by open reduction and internal fixation with an average follow-up of 3.7 years (1.5-4.0) are reported. Reduction leaving a displacement of < or = to 2 mm was achieved in 9 hips (30%). Good or excellent results were obtained in 22 hips (82%), and in 2 patients who were referred to us after 3 weeks, we performed supra-acetabular osteotomy to obtain congruent joints with fairly good results. The most common complication was heterotopic ossification in 59% of the patients, which led to poor results in 2 patients with grade IV. Avascular necrosis of the hip occurred in 2 patients, and 1 patient developed a late deep infection, which led to osteomyelitis and fused hip.