Eighteen patients who were sixty years or older and had an acute displaced fracture of the acetabulum were managed with open reduction and internal fixation. The average age of the patients was sixty-seven years (range, sixty to eighty-one years). Nine fractures were a result of a motor-vehicle accident, and nine occurred in a fall. Nine patients had multiple associated injuries, and most (sixteen patients) had other complex acetabular fractures. All of the patients had open reduction and internal fixation with either the ilioinguinal approach (thirteen patients) or the Kocher-Langenbeck approach (five patients). All patients were managed postoperatively with early mobilization and physical therapy. All fractures united, and only one patient had a partial loss of reduction. Four patients who had a concentric reduction had a gap of as much as three millimeters in the articular surface due to comminution of the fracture. The complications included two pulmonary emboli, which resolved with anticoagulation, and one undetected intra-articular fragment, which led to an additional operation. No infections or iatrogenic nerve injuries were noted. Seventeen of the eighteen patients were followed for at least two years (average, thirty-one months). These patients had an average Harris hip-score of 90 points postoperatively. The treatment was regarded as having failed in only one patient. Open reduction and internal fixation of selected displaced acetabular fractures in the elderly can yield good results and may obviate the need for early and often difficult total hip arthroplasty.