Objective To investigate the effect of treating posterior pelvic ring fractures using manual repositioning and sacroiliac joint screw fixation. Methods From June 2006 to March 2008, 12 patients with posterior pelvic ring fractures were treated with manual repositioning and internal fixation with sacroiliac joint tension screws. The 12 patients in this group were 8 males and 4 females, aged 34-41 years, with an average age of 36.4 years. The cause of injury was a car accident in 7 cases and a fall from height in 5 cases. The post-injury consultation time was 2h-2d, and all of them were closed injuries, among which, 3 cases were in hemorrhagic shock. According to the AO pelvic ring injury method typing, there were 7 cases of type B, including 4 cases of type B2, 3 cases of type B3, and 5 cases of type C, including 4 cases of type C2 and 1 case of type C3. General anesthesia was used, and the prone position was adopted. The operator placed one hand on the posterior superior iliac spine of the affected side and the other hand on the anterior superior iliac spine of the affected side. For inversion-type sacroiliac joint dislocation, the affected pelvis is pushed in the direction of outward rotation; for ectropion-type sacroiliac joint dislocation, the affected pelvis is pushed in the direction of inward rotation. During the process of dislocation, continuous force should be applied, and excessive force should not be applied for the purpose of repositioning, which may cause new fractures. During the repositioning process, fluoroscopy is performed to understand the repositioning situation until it is satisfactory. An incision of about 3 cm is made 2 cm below the posterior superior iliac spine, and the needle is selected to be inserted 2 cm outside the posterior superior iliac spine and 3 cm below the iliac crest. During the process of needle insertion, it is necessary to repeatedly fluoroscope the pelvic entry and exit positions to avoid penetration of the guide needle into the anterior side of the sacrum or the spinal canal. After fluoroscopy, the 6.5 mm tension screw was screwed in for fixation. Results All cases in this group were followed up for 4 months-11 months, with a mean of 5.7 months. The patients were able to perform functional exercises of the hip and knee on the second day after surgery; they were able to move with the abutment on the ground after 6 weeks; and they were able to bear full weight after 12 weeks. All the cases in this group obtained satisfactory results after treatment and were able to take care of themselves and participate in physical labor. No nerve injury or screw loosening occurred in this group of cases. Discussion Sacroiliac joint screw technique is used, which has small surgical incision, real fixation, compression effect and simple operation. The surgical results of this group of cases show that the treatment of posterior pelvic ring fractures with the technique of manipulative repositioning and sacroiliac joint screw fixation has great clinical application value.