STUDY DESIGN: Case report and review of the literature.OBJECTIVE: The current literature aimed to look specifically into the clinical characteristics of such complicated and rare injury and its surgical management, especially the reduction process and the matching surgical approach and fixation method, of difficult obsolete anterior fracture-dislocation of sacroiliac joints by presenting a typical case and the related literature.SUMMARY OF BACKGROUND DATA: Anterior fracture dislocation of sacroiliac joint is a kind of severe and rare high energy trauma with high morbidity and mortality, usually complicated with circulation instability, visceral injury, hemothorax or pneumohemothorax, and et al.And thus when it comes to be handled by specialized orthopedists, its frequently obsolete, and therefore its surgical management, especially the reduction process can be difficult.METHODS: A difficult and complicated case of obsolete anterior fracture-dislocation of sacroiliac joint in a 19-year old young man and its treatment through open reduction via anterior approach with help of Schantz screws and internal fixation with hollow screws, were reported to elicit the characteristic of such complicated and rare injury and its surgical management.A search and review of the English language literature was presented, also.RESULTS: The intra-operative blood loss was about 600ml.post-operative X-ray radiograph and CT scan showed that the pelvic fracture dislocation was reduced.At the end of the follow-up, there was no improvement or deterioration of the neural symptoms.Literature review showed that such injuries are usually caused by high energy trauma and are more likely to be children or teenagers, and that there was a conflict of understanding in the surgical management, especially the choice of surgical approach, for such cases.CONCLUSION: Different surgical approaches and the matching reduction and fixation methods should be chosen depending on the severity, complicity and the injury time of the specific case.High quality clinical proof with large sample size and long-term follow-up is needed in this area.