Pelvic ring and acetabular injuries represent one of the most demanding fields of orthopaedic trauma surgery because of complex anatomy, associated neurovascular and visceral risks, and substantial variation in fracture morphology. This reviews anterior approaches used in pelvic injuries with emphasis on indications, technical principles, advantages, limitations, and strategies to avoid complications. The Pfannenstiel/anterior symphyseal approach, external fixation, anterior subcutaneous internal fixation, percutaneous screw fixation, ilioinguinal approach, modified Stoppa/anterior intrapelvic approach, and pararectus approach are discussed in light of current surgical concepts. Anterior approaches are particularly relevant in pubic symphysis disruption, anterior pelvic ring instability, superior pubic ramus fractures, anterior column fractures, anterior column-posterior hemitransverse patterns, and acetabular fractures involving the quadrilateral surface. The choice of approach should not be based solely on fracture classification; direction of displacement, posterior ring or posterior column involvement, soft-tissue condition, overall clinical status, and surgeon experience should also guide decision-making. Safe surgery requires careful preoperative computed tomography assessment, recognition of vascular variations, and meticulous protection of the corona mortis, external iliac vessels, obturator nerve, femoral nerve, bladder, and urogenital structures. In conclusion, successful anterior pelvic and acetabular surgery depends less on the superiority of a single approach and more on fracture-specific planning, anatomical reduction, stable fixation, and anticipation of approach-related complications.