Objective To compare the efficacy of percutaneous hollow screw internal fixation and anterior plate internal fixation in the treatment of unstable pelvic fracture in elderly patients. Methods Clinical data of 48 patients (aged from 60 to 72 years) with unstable pelvic fractures admitted in our department from February 2014 to February 2019 were collected and retrospectively analyzed. According to their surgical treatment, they were divided into screw group (n=21) and plate group (n=27). The perioperative indices, visual analogue scale (VAS) score of the incision in 12 h after operation, incidence of complications, excellent rate of fracture reduction at discharge and Majeed score in 6 months after operation were compared between the 2 groups. SPSS statistics 13.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for the comparison between groups. Results There was no significant difference between the baseline data of the two groups. The screw group had significantly smaller intraoperative bleeding volume [(35.7±5.7) vs (467.3±210.4)ml], shorter operation time [(56.3±11.7) vs (110.3±24.6)min], lower VAS score of the incision in 12 h postoperatively [(2.81±0.79) vs (5.44±1.17)], shorter length of hospital stay [(8.5±2.9) vs (18.6±5.1)d], and less incidence of postoperative complications (4.8% vs 14.8%) when compared with the plate group (P<0.05). But there were no statistical differences in the excellent rate of fracture reduction at discharge (95.2% vs 88.9%) and Majeed score in 6 months after operation [(88.2±5.9) vs (85.1±6.3)] between the 2 groups (P>0.05). Conclusion In the treatment of unstable pelvic fracture in the elderly, percutaneous hollow screw internal fixation and anterior plate internal fixation have similar efficacy. But the former has the advantage of minimal invasion and is worthy of clinical promotion.