Aims: Functional outcome following pelvic ring fractures is closely correlated with the anatomic results. ORIF is correlated with good anatomic results but with morbidity. Isolated sacro-iliac screws are inadequate. We assessed outcome after complete Minimal-Invasive-Surgery. Methods: Between 1998 and 2001, 21 consecutive patients with unstable pelvic-ring disruptions [15 AO C, 6 AO B] were treated operatively. In a supine position, after close reduction of the fractures, anterior þxation, percutaneous stabilization of the posterior lesions was accomplished using ßuoroscopically-guided ilio-transsacral 7,3 mm cannulated lag-screws inserted through the body of S1 to the opposite sacroiliac joint. Results: Delay from injury to þxation was 4 (0–8) days. 13 anterior þxations and 21 ilio-transsacral cannulated screws were placed. No secondary complications. The main outcome was 2 years; radiographically, 19 anatomic reductions of the posterior fractures and 2 vertical ascensions (5 mm) were achieved. The mean Majeed score was 95. Conclusions: Early stabilization of instable pelvic-fractures in a supine position using percutaneous ilio-transsacral screws and anterior þxation is a technique that lends itself to a variety of unstable pelvic fractures. This diminishes potential blood loss and operative times in multiply injured patients. An obvious limitation in the percutaneous technique is the inability to restore the normal anatomy. Surgical stabilization allows early mobilization of the patients, prevents progressive deformity and obtains good functional results.