The purpose of this study was to assess the technical success, intervention duration, radiation exposure, and safety of cone-beam computed tomography (CBCT)-guided percutaneous screw fixation in treating traumatic pelvic ring and acetabular fractures.

All consecutive patients with unstable pelvic ring (Tile B/C) or acetabular fractures treated by CBCT-guided percutaneous osteosynthesis between March 2023 and September 2025 were included. All interventions were performed using CBCT navigation with bull's eye guidance. Outcomes were technical success ( i.e. , fully intraosseous screw trajectory without cortical breach), intervention duration, dose-area product (DAP), and perioperative complications, and their associations or correlations with fracture classification, screw count, and body mass index .

Sixty-seven patients underwent CBCT-guided fixation. There were 45 men and 22 women, with a mean age of 50.8 ± 18.5 (standard deviation) years (range: 17–91 years) and a median body mass index of 24.8 kg/m² (Q1, 22.3; Q3, 27.2; range: 16.7–42.2 kg/m²). Overall, 102 out of 103 screws (99.0 %) followed the planned intraosseous trajectory. No intraoperative complications were observed. One patient (1/67; 1.5 %) developed immediate postoperative nervous pain requiring screw adjustment with rapid pain relief. Median intervention duration was 43 min (first quartile [Q1], 30; third quartile [Q3], 54.5; range, 19–107 min) with a moderate correlation with the number of screws (ρ = 0.496). Median DAP was 81.6 Gy·cm² (Q1, 59.1; Q3, 101.5; range, 11.8–226.5 Gy·cm²) with a weak correlation with body mass index (ρ = 0.311).

CBCT-guided percutaneous pelvic fixation is safe and effective in the management of traumatic pelvic fractures and may represent a minimally invasive alternative to open surgery or conventional fluoroscopy for patients with this condition.