Introduction <p>Modifiable patient-related factors contribute to morbidity and functional outcomes after acetabular fracture. This study will investigate the relationship between tobacco smoking and patient-reported functional outcomes after acetabular fracture.</p> Materials and methods <p>A retrospective cohort study of 770 patients with 782 acetabulum fractures was performed following operative (<i>n</i> = 535, 68%) or non-operative (<i>n</i> = 247, 32%) management. Musculoskeletal Function Assessment (MFA) scores were assessed a minimum of 12-months after injury in 37.5% of patients.</p> Results <p>Tobacco smoking was pervasive with 44% current users and 14% former users. Current tobacco smokers had higher associated MFA scores, when compared to former and never smokers (42.7 vs. 36.5 and 26, <i>p</i> &lt; 0.001). On linear regression analysis, history of tobacco smoking (current or former) was a risk factor for higher, worse outcomes on the MFA (B = 9.86, <i>p</i> = 0.02).</p> Conclusions <p>Current or former tobacco smoking was predictive of worse patient-reported functional outcomes scores after acetabular fracture.</p> Level of evidence <p>Level III, Prognostic.</p>