Central fracture of the acetabulum is an uncommon traumatic lesion of the pelvis that is usually best managed by conservative measures. Adequate roentgenographic evaluation and closed manipulation followed by skeletal traction is essential to attain and maintain congruity of the weight-bearing dome with the femoral head. Reduction should be maintained with traction continued uninterrupted for three months. Open reduction and internal fixation may be warranted if the actabular dome elements are of sufficient size for reconstruction of the pelvic wall. An early exercise program will improve and, as a rule, restore the range of hip joint motion. Protected weight-bearing may safely begin approximately three to four months post-injury.