Pelvic ring and acetabular fractures are complex injuries associated with substantial morbidity [[1], [2], [3], [4], [5], [6]]. Conservative management often necessitates prolonged bed rest, leading to muscle atrophy and complications. Open surgical fixation is effective but invasive and carries hemorrhagic and neurologic risks [7]. Fluoroscopy-guided percutaneous screw fixation reduces surgical morbidity but remains technically demanding, especially in obese patients or in cases with narrow osseous corridors such as the first sacral segment (S1 corridor) [[8], [9], [10], [11], [12], [13], [14], [15], [16], [17]]. Malpositioned sacroiliac screws can result in nerve or vascular injury.

Cone-beam CT (CBCT)-guided navigation with bull's eye and progression views, currently used in interventional oncology, provides highly precise three-dimensional trajectory planning and real-time confirmation of intraosseous screw advancement [[18], [19], [20], [21], [22]]. Prior studies have focused on oncologic or degenerative indications rather than acute trauma and, to our knowledge, no study has specifically evaluated the feasibility of CBCT-guided osteosynthesis for traumatic pelvic ring and acetabular fractures [[23], [24], [25], [26], [27], [28], [29], [30], [31]].

The purpose of this retrospective study was to evaluate the technical success rate, intervention duration, radiation exposure, and safety of CBCT-guided percutaneous pelvic screw fixation for the management of traumatic pelvic ring and acetabular fractures.