Introduction: Surgical treatment of acetabular fractures in elderly people is challenging. The main aim of this study is to evaluate retrospectively the indications, results and the complications of simultaneous open reduction and internal fixation (ORIF) and acute total hip replacement (THR) in the management of displaced acetabular fractures.

Methods This study was performed in an academic level I trauma centre. From January 2011 to December 2014, a consecutive series of 18 patients (eight females), with average age of 66 years (range 35–81 years) who had displaced acetabular fractures were included in our study. All patients underwent ORIF and simultaneous acute THR. The average duration of follow up was 21.7 months (range 12–36 months).

Results At the latest follow up, all patients could walk independently. Thirteen patients (72.7 %) had excellent Harris hip scores HHS, five, patients (27.7 %) had good results. All fractures were healed and the acetabular autologous bone grafts were well incorporated. There were no delayed unions or non-unions. Two patients (11 %) had heterotropic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups however one patient had 2 mm medial migration of the cup. No vertical migration was observed, and there were no signs of loosening around the femoral stem