Purpose <p>To identify fracture characteristics associated with the selection of closed reduction (CR) or open reduction (OR) for anterior pelvic ring fixation in patients with straddle fractures and to evaluate the radiographic, functional, and complication outcomes following an indication-based treatment strategy.</p> Methods <p>This retrospective study included 69 patients with straddle fractures treated surgically between 2016 and 2021. Patients were classified according to the anterior pelvic ring reduction technique as bilateral CR (<i>n</i> = 25) or OR on at least one side (<i>n</i> = 44). Fracture characteristics associated with treatment selection were analyzed, and perioperative, radiographic, functional, and complication outcomes were compared between groups.</p> Results <p>Compared with fracture sites treated with CR, fracture sites treated with OR more frequently demonstrated medial involvement and greater axial displacement. After adjustment for potential confounders, medial fracture involvement and AO/OTA Type A injury, compared with Type B injury, were independently associated with the selection of OR. OR was associated with longer operative time and greater blood loss (both <i>P</i> &lt; 0.001). Radiographic reduction was maintained during follow-up, and no significant differences were observed between groups in radiographic stability, overall functional outcomes, or postoperative complication rates.</p> Conclusions <p>Medial fracture involvement was independently associated with the selection of OR. AO/OTA Type A injury was also associated with OR, although this estimate was imprecise and should be interpreted cautiously. These findings support an indication-based treatment strategy guided by fracture morphology and the anticipated feasibility of satisfactory indirect reduction.</p>