Objectives: To compare cell salvage (CS) volume, intraoperative blood loss, intraoperative blood transfusions, and operative time for acetabular fractures undergoing early (≤48 hours from admission) versus delayed fixation (>48 hours from admission). Design: Retrospective. Setting: Level one trauma center. Patients: One hundred thirty-one patients with unilateral acetabular fractures involving at least one column. Intervention: Open reduction and internal fixation performed through the anterior intrapelvic approach or posterior approach. Main Outcome Measurements: CS volume, estimated blood loss (EBL), intravenous fluids (IVFs), intraoperative packed red blood cells (PRBCs), and operative time. Results: Early versus delayed fixation through the posterior approach was associated with shorter operative times and less intraoperative PRBCs (140 vs. 301 mL, MD −161 mL, 95% confidence interval −25 to −296 mL) with no differences in CS, EBL, or IVF. Early versus delayed fixation through an anterior intrapelvic approach was more common in less severe fracture patterns with no differences in PRBCs, CS, EBL, or IVF. CS, through either approach, was successful in returning blood to 77% of patients for an average of 267 ± 168 mL (range, 105–900 mL). Conclusions: Fixation of acetabular fractures within 48 hours of admission did not increase blood loss or intraoperative transfusions. CS was successful in returning an average of one unit of blood to a majority of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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