With the aging of the population and the prevalence of modern transportation, pelvic fractures, a high-violence fracture, are gradually occurring in the elderly population. However, pelvic fractures have a high level of occult bleeding. Traditional open surgery also has high bleeding. The elderly also cannot tolerate prolonged bed rest. Especially for unstable pelvic fractures, even with the use of pelvic pockets, care for the elderly is very difficult. Although minimally invasive pelvis is a good treatment option, the procedure is very difficult, especially in osteoporotic cases. This is an 80-year-old elderly man with trauma to multiple pelvic fractures and ankle fractures, and the elderly man is atrial fibrillation heart rate. Hemorrhagic shock was present at the time of injury. More than 2000 ml of blood was transfused to stabilize the situation. The D-dimer, which represents thrombosis, was persistently elevated in the elderly, indicating a risk of coagulation thrombosis. Because of the cranial injury, neurosurgery prohibits anticoagulation and can only reduce thrombosis through physical activity methods, but because the pelvis is unstable with multiple fractures, the elderly man’s lower extremity motion induces pain and aggravates the pelvic bleeding. After screening vascular ultrasound and inferior vena cava angiography, we performed minimally invasive pelvic fracture fixation surgery and ankle incision and internal fixation for the elderly. In order to obtain pelvic stability to reduce invisible blood loss and facilitate lower limb exercise. Intraoperative bleeding was 150 ml, and the pelvis of the elderly was well stabilized.