Summary: Stabilization of pelvic ring injuries and certain acetabular fractures using percutaneous techniques is becoming increasingly more common. Intramedullary superior ramus screw fixation is beneficial in both injury types. While implants can be placed in an antegrade or retrograde direction, parasymphyseal ramus fractures benefit from retrograde implant insertion. In some patients, the parabolic osseous anatomy or obstructing soft tissues of the anterior pelvis or thigh can prevent appropriate hand and instrumentation positioning for appropriate retrograde ramus screw insertion through the entire osseous fixation pathway. Instead of abandoning medullary fixation, we propose a technique utilizing cannulated screws to successfully place retrograde screws in this distinct clinical scenario.