Objective  To analyze the clinical efficacy of orthopedic robot-guided percutaneous cannulated screw internal fixation on patients with pelvic fractures retrospectively. MethodsTotally 182 patients with pelvic fractures who were treated in Department of Traumatic Orthopedics of Taihe Hospital, Affiliated Hospital of Hubei University of Medicine from January 2023 to December 2024, were divided into observation group (n=91) and control group (n=91) by random number table method. Both groups were treated with percutaneous cannulated screw internal fixation, and the observation group was combined with orthopedic robot guidance. The pelvic reduction status, serological indicators ［serum peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), alkaline phosphatase (ALP), D-dimer (D-D)］, surgery-related indicators, pain score, pelvic function and incidence rates of long-term complications were compared between the two groups of patients. ResultsAfter 6 months of surgery, the total excellent and good rate of pelvic reduction of patients in observation group was higher than that in control group (P<0.05). Before discharge, the levels of PGC-1α and ALP in the two groups increased, and the levels in observation group were higher than those in the control group (P<0.05), and D-D level decreased, and the level in observation group was lower (P<0.05). The surgical screw placement time, screw placement time, surgical time, incision length, hospitalization time and fracture healing time in observation group were shorter compared to the control group (P<0.05), and the intraoperative fluoroscopy frequency and intraoperative blood loss volume were less (P<0.05), and the accuracy rate of screw placement was higher than that in the control group (P<0.05). On 12 hours, 3 days and 7 days after surgery, the visual analogue scale(VAS) scores in the two groups of patients were reduced compared with that before surgery, and the score was lower in the observation group (P<0.05). The recovery of pelvic function in observation group after 6 months of surgery was better than that in the control group (P<0.05). The observation group had lower incidence rates of long-term complications than the control group (P<0.05). Conclusion Orthopedic robot-guided percutaneous cannulated screw internal fixation can promote the pelvic reduction in patients with pelvic fractures, while also promoting the fracture healing and pelvic function recovery, improving the accuracy rate of screw placement, regulating the bone metabolism, improving the body’s hypercoagulable state, reducing pain, and minimizing the occurrence of long-term complications.