Background <p>Severe pelvic trauma during pregnancy is rare and requires concurrent maternal and fetal management. Multidisciplinary coordination is essential, yet reports of definitive pelvic fixation with the fetus in utero are exceptionally uncommon.</p> Case presentation <p>A 28-week pregnant woman with no prior medical history sustained severe injuries (Injury Severity Score: 16) in a high-energy collision. Diagnostic imaging revealed a comminuted, displaced right hip fracture, sacral avulsion fractures, right-sided sacroiliac joint diastasis, and a large pre-sacral pelvic hematoma. Abdominal ultrasound confirmed a viable fetus with no signs of distress and no placental hematomas. The patient was admitted to intensive care unit for preoperative optimization, including fluid resuscitation, transfusion, and pain management. Continuous maternal monitoring and daily fetal assessments were performed. Following multidisciplinary consultations with obstetricians, neonatologists, traumatologists, and intensive care specialists, temporary right lower limb traction was applied, followed by closed reduction and screw osteosynthesis of the iliac bone and sacrum. Surgery was conducted with a perinatal team prepared for emergency cesarean delivery. No intraoperative fetal distress was observed. Postoperative recovery was uneventful, and the patient subsequently delivered a healthy male infant at term.</p> Conclusion <p>This case contributes to the limited body of literature describing successful internal pelvic fixation during pregnancy with fetal retention until term. It illustrates that, with vigilant monitoring and collaborative, protocol-driven management, definitive orthopedic intervention can be planned and performed deliberately while achieving favorable maternal and fetal outcomes.</p>