Minimally invasive percutaneous screw fixation of the pelvic ring in combination with closed, minimal access, or open reduction is safe and can be successfully applied to a variety of sacral, iliac, and pubic fractures and combinations thereof. The placements of sacroiliac and superior pubic ramus screws are the most widely used examples of this technique. Treatment of acetabular fractures is also feasible, with the restriction that a precise reduction of joint surfaces has to be achieved before percutaneous fixation is attempted to reduce the risk of developing secondary osteoarthritis. A critical and rational interdisciplinary selection of the best treatment modality for every patient is of extraordinary importance and may often be the most difficult part within the treatment process. An excellent quality of pre- and intraoperative imaging, image guidance, navigation, or robotic assistance is crucial for a good outcome.