Fixation of acetabular fractures requires a clear understanding of fracture morphology, displacement vectors, reduction strategies, and implant application. Once the reduction is achieved and maintained, the next critical step is definitive fixation—often accomplished through targeted screw placement within well-defined osseous pathways.

In recent years, minimally invasive techniques—particularly percutaneous screw fixation under fluoroscopic guidance—have gained popularity. These approaches aim to achieve stable fixation with reduced surgical morbidity, making them especially attractive in selected patient populations [[1], [2], [3]]. However, the anatomical corridors used for percutaneous screws are not exclusive to these techniques. In fact, the same bony trajectories are frequently utilized during open procedures, through plates or not, as part of standard internal fixation constructs.

This article focuses on key periacetabular screws commonly used in acetabular fractures surgery, whether inserted as standalone implants, percutaneously, or through plates during open reconstruction. Each screw is addressed not merely as a trajectory, but as a functional fixation element defined by its specific indications, osseous course, imaging requirements, and technical nuances. This screw-focused framework is designed to guide surgical planning and execution by correlating fracture morphology, implant selection, and anatomical feasibility in acetabular fixation.