Objective <p>To evaluate the clinical efficacy of the Rossum Robot in assisting full-process closed reduction and internal fixation for low-energy osteoporotic unstable pelvic fractures in elderly patients.</p> Methods <p>We performed a retrospective analysis of the clinical data of 37 patients with osteoporotic unstable pelvic fractures due to low-energy trauma, who underwent robotic reduction and internal fixation surgery between October 2023 and May 2024. Eighteen patients underwent Rossum Robot-assisted full-process closed reduction and internal fixation (RoRobot group), while 19 patients underwent percutaneous screw fixation with TiRobot assistance (TiRobot group). We compared the excellent and good rate of fracture reduction (EGR), the accuracy of screw placement (ASP), and the degree of fracture healing between the two groups. Efficacy indicators included changes in the Visual Analogue Scale (VAS) for pain and the Majeed score at preoperative, 1-week, 1-month, 3-month, and 6-month follow-ups. Statistical correlations were assessed using independent t-tests, chi-square tests, and non-parametric tests.</p> Result <p>The EGR in the RoRobot assistance group was significantly higher than that in the control group (<i>P</i> = 0.019). No significant difference was observed in fracture healing between the two groups post-surgery (<i>P</i> = 0.157). No significant difference was found in ASP between the RoRobot and TiRobot assistant groups (<i>P</i> = 0.619). No significant difference was observed in the preoperative VAS and Majeed scores between the two groups (<i>P</i> = 0.611, <i>P</i> = 0.939). Both groups showed significant improvement in VAS scores post-surgery. One week and one month after surgery, the VAS score in the RoRobot assisted group was significantly lower than in the TiRobot assisted group (<i>P</i> = 0.000, <i>P</i> = 0.001). Majeed scores significantly increased in both groups post-surgery, and during multiple follow-ups within six months, the RoRobot assisted group showed significantly higher Majeed scores than the TiRobot assisted group.</p> Conclusion <p>In elderly patients with osteoporotic unstable pelvic fractures resulting from low-energy injuries, Rossum robot-assisted pelvic fracture closed reduction and internal fixation surgery leads to less tissue damage, more effective fracture reduction, better postoperative pain relief, and faster recovery compared to TiRobot-assisted internal fixation surgery.</p>