The pelvic subcutaneous cross-over internal fixator is a minimally invasive technique for the fixation of instable anterior pelvic ring fractures. A USS-II-VAS screw is anchored bilaterally in the supra-acetabular region of the os ileum by a mini-incision approach. An angled fixation rod is inserted subcutaneously and after successful closed reduction attached to the screws forming a locking internal fixation. In a retrospective study of the clinical and radiological outcomes of 19 patients after an average follow-up of 2.54 years, results were excellent and good in 31.6%, moderate in 63.2% and poor in 5.3%. Complications were one wound infection, one loosening of the VAS screw and seven temporary lesions of the lateral femoral cutaneous nerve. The main benefits are a simple surgical technique preventing damage to soft tissue, a low risk of neurovascular lesions and the avoidance of pin infections. Moreover patients with multiple trauma profit from a shorter time of surgery and greater comfort allowing a prone position. The new procedure combines the advantages of internal osteosynthesis and a minimally invasive technique, providing early mobilization under full-weight bearing for instable pelvic fractures.