This chapter provides an overview of the epidemiology, classification, radiological assessment and treatment of acetabular fractures in the geriatric population. Acetabular fractures in this group of patients are challenging to manage as they frequently consist of complex fracture patterns in the presence of reduced bone mineral density, pre-existing hip disease and medical comorbidities. Acetabular fractures have a bimodal distribution. High energy blunt trauma accounts for the majority of fractures in young patients, while low energy trauma is primarily responsible for these injuries in elderly patients. The main indication for non-operative management of acetabular fractures in elderly patients is the presence of a stable, concentrically reduced fracture not involving the weight-bearing surface. The principles behind delayed Total hip replacement (THR) are analogous to revision arthroplasty in the presence of acetabular bone loss. Delayed THR for geriatric acetabular fractures can be performed for post-traumatic osteoarthritis following unsuccessful non-operative or operative management.