Pelvic ring injuries, although comprising only 2–8 % of all skeletal injuries, are associated with high morbidity and mortality rates due to their frequent association with polytrauma, hemorrhage, and multisystem trauma [[1], [2], [3]]. Mortality from pelvic ring injuries ranges from 5 to 16 %, with open pelvic fractures carrying a mortality rate of up to 45 % [4]. Management options include nonoperative care, open reduction and internal fixation (ORIF), percutaneous pelvic fixation (PPF), or hybrid approaches. Choice of technique may be guided by injury pattern, stability, and patient-specific factors [2,5].

Pelvic ring injuries have been reported to occur in a bimodal distribution with variability of mechanism of injury. Younger adults are more likely to sustain high-energy trauma such as motor vehicle collisions or falls from height. These injuries typically result in unstable high-energy anteroposterior compression (APC) or vertical shear injuries [3,6,7]. These injuries often require open reduction and internal fixation to achieve an anatomic reduction and biomechanical stability. In contrast, older adults more commonly sustain low-energy lateral compression injuries following ground-level falls, with partial disruption of the posterior ring [[8], [9], [10]] . These fractures may be treated non-operatively or with percutaneous pelvic fixation depending on fracture pattern stability. The literature has demonstrated acceptable functional outcomes for both treatment modalities [[11], [12], [13]].

In recent years, percutaneous pelvic fixation (PPF) has gained popularity for select injuries due to minimization of intraoperative blood loss, decreased wound complications, and shorter hospital stays compared to open surgical techniques [[14], [15], [16], [17], [18], [19]]. These benefits are particularly relevant among older adults with chronic comorbidities. Furthermore, intraoperative imaging, navigation, and robotic guidance have further facilitated the adoption of minimally invasive pelvic fixation, particularly for posterior ring injuries [[20], [21], [22]].

Despite growing clinical interest, few studies have quantified how the use of PPF has evolved over time, particularly among early-career orthopaedic trauma surgeons. Between 2003 and 2015, National and international database reports have reported shift in practice of percutaneous pelvic surgery [[23], [24], [25]].

Given the continued use and expansion of percutaneous pelvic fixation, the purpose of this study is to evaluate national trends in the operative management of pelvic ring injuries by early-career orthopaedic trauma surgeons from 2003 to 2023. Analysis of trends in fixation of pelvic ring injuries stratified by younger (18–50) and older (≥65) patients was also conducted.