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OBJECTIVES To explore the association between increased time in traction and in-hospital pulmonary complications in patients with acetabular fractures DESIGN.: Retrospective. SETTING Level I trauma center. PATIENTS/PARTICIPANTS One-hundred ninety consecutive patients. INTERVENTION Application of skeletal traction prior to fixation of acetabular fracture. MAIN OUTCOME MEASUREMENTS The primary outcome measure was pulmonary complication as defined by pulmonary embolism, pneumonia, and acute respiratory distress syndrome (ARDS). Secondary outcome measures included length of ICU stay (in days), total length of hospital stay (in days), deep hardware-associated infection, subsequent conversion to total hip arthroplasty (THA), urinary tract infection (UTI), and lower extremity deep venous thrombosis (DVT). RESULTS The mean time in traction for patients that suffered a pulmonary complication was 210 hours compared to 62 hours for those that did not (p<0.001). After controlling for ISS, chest injury, and concomitant long bone injury requiring intramedullary nailing, the odds of developing a pulmonary complication for patients that spent longer than 120 hours in traction were over 40 times higher than those treated within 5 days (p<0.001). The mean ICU stay for patients that spent at least 120 hours in traction was 17 days compared to 5 days for those treated in less than 120 hours (p<0.001). CONCLUSION Early definitive fixation and decreased time in skeletal traction is associated with a lower rate of complications in patients with acetabular fractures. Our results would suggest that fixation of acetabular fractures prior to 120 hours (5 days) confers a significant risk reduction benefit. LEVEL OF EVIDENCE Level III.