- Objectives The purpose of this study was to compare the results of immediate and delayed percutaneous sacroiliac screws surgery for unstable pelvic fractures, regarding technical results and complication rate. DesignRetrospective study. SettingThe study was conducted at the Soroka University Medical center, Beer Sheva, Israel, which is a level 1 trauma Center. Patients108 patients with unstable pelvic injuries were operated by the orthopedic department at the Soroka University Medical Center between the years 1999–2010. A retrospective analysis found 50 patients with immediate surgery and 58 patients with delayed surgery. Preoperative and postoperative imaging were analyzed and data was collected regarding complications. InterventionAll patients were operated on by using the same technique—percutaneous fixation of sacroiliac joint with cannulated screws. Main outcome measurementsThe study’s primary outcome measure was the safety and quality of the early operation in comparison with the late operation. ResultsA total of 156 sacroiliac screws were inserted. No differences were found between the immediate and delayed treatment groups regarding technical outcome measures (P value = 0.44) and complication rate (P value = 0.42). Conclusions The current study demonstrated that immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produced equally good technical results, in comparison with the conventional delayed operation, without additional complications.