Abstract:[Objective] To compare the clinical consequences of external frame fixation of Tile type B pelvic fractures with or without pubic ramus pining. [Methods] A retrospective research was performed on 42 patients who were treated with external fixators for Tile type B pelvic fractures from January 2019 to April 2022. According to the results of preoperative patient-patient discussion, 22 patients received external frame with iliac crest and pubic ramus pining (PRP group), while the other 20 patients underwent external fixator with iliac crest pining alone (non-PRP group). The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All the patients in both groups were operated smoothly, with no vascular, nerve injury and other complications. The PRP group was significantly greater than the non-PRP group in terms of operation time [(36.8±5.8) min vs (24.5±5.1) min, P＜0.001], the total length of incision [(6.1± 0.6) cm vs (4.1±0.5) cm, P＜0.001], intraoperative blood loss [(27.9±7.2) ml vs (17.1±6.8) ml, P＜0.001] and intraoperative fluoroscopy times [(9.1±1.8) times vs (6.6±1.6) times, P＜0.001], but the former proved significantly superior to the latter in terms of the time to resume walking [(22.8±2.4) days vs (41.9±3.8) days, P＜0.001], hospital stay [(12.2±1.8) days vs (19.4±2.8) days, P＜0.001] and the time recover full weight-bearing activity [(45.7±6.6) days vs (60.7±9.4) days, P＜0.001]. The VAS scores, hip flexion-extension range of motion (ROM), internal and external rotation ROM and Majeed scores were significantly improved in both groups with postoperative time (P＜0.05). The PRP group was significantly better than the non-PRP group regarding VAS score [(2.8±1.1) vs (4.2±1.7), P=0.004], hip extension-flexion ROM [(147.8±13.3)° vs (139.5±11.9)°, P=0.038], the internal-external rotation ROM [(69.8±8.4)° vs (64.2±6.2)°, P=0.020] and Majeed scores [(76.1±9.3) vs (65.2±7.0), P＜0.001] one month after operation. With respect of imaging, there were no statistically significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05). [Conclusion] The clinical effect of external fixator with both iliac and pubic ramus pining is considerably better than that with iliac pining only for Tile type B pelvic fractures.