This study prospectively analyzes the outcomes of 30 patients with unstable posterior pelvic ring injuries who underwent either percutaneous iliosacral screw fixation or conservative management from 2016 to 2018 at trauma care center (level 1). The effectiveness of these two approaches is evaluated by comparing functional, clinical, and radiographic outcomes. Comparative Analysis of Percutaneous Iliosacral Fixation for Unstable Posterior Pelvic Ring Injuries This retrospective cohort study evaluates the effectiveness of percutaneous iliosacral screw fixation versus conservative management for treating unstable posterior pelvic ring injuries. Patient cohorts were assessed using the Majeed grading system for functional outcomes, the 36-Item Short Form Health Status Survey (SF-36) for general and mental health status, and radiographic analysis to determine residual displacement at 1 year. Furthermore, pain relief was evaluated at 1-month and 1-year post-operative intervals.Findings indicate that surgical intervention achieves significantly better functional outcomes than conservative treatment. Percutaneous iliosacral fixation demonstrably reduces residual displacement at medium-term follow-up and provides superior pain management at both short- and medium-term follow-up assessments. Conclusion: Percutaneous iliosacral screw fixation represents a valuable therapeutic option for managing unstable posterior pelvic ring injuries, offering superior functional results and mitigating long-term sequelae compared to conservative management strategies.