Fifty patients with unstable pelvic fracture were subjected to internal fixation through anterior approach by small fragment biosynthesis over sixteen year of experience. Their age, range between 15–45 years. Forty patients were males and ten patient females. Thirty patients with type B rotationally unstable fracture pelvis, 15 patients with type C vertically unstable and 5 patients with combined rotationally and vertically unstable fracture. In type B fracture, 30 patients were surgically approached anteriorly by pfennenstiel incision, while type C (15) patients required ilioinguinal extension to fix anterior and posterior ring. Combined unstable fracture in 5 patients require anterior and posterior approach as two stages surgical exposure with one week interval. It is concluded that anterior approach to displaced pelvic fracture was good and suitable for young and thin patients. In addition anterior ring fixation was the key for anatomical reduction of displaced fracture and horizontal application of small fragment implant across the sacroiliac joint and anterior ring could be achieved and maintain the stability if full weight bearing is delayed to 6 month. Other advantages and limitation of the procedure were discussed.