The treatment of acetabular fractures has evolved considerably in the past three decades. Associated injuries to the femoral head, proximal femur, or femoral shaft can complicate the initial management of the acetabular fracture, and mandate a careful treatment strategy for optimal treatment of both the acetabular fracture and associated injury. These injuries may have a large impact on the clinical outcome. The surgeon must consider surgical approaches, timing, and alternative modes of fixation. A discussion with case illustrations is provided.