Abstract: Pelvic arterial injuries caused by pelvic or acetabular fractures are rare (15%-20%), and the complication by externaliliac artery (EIA) injuries is even rarer, which can result in a mortality rate as high as 75%-83%. The mechanism of major arterydamage caused by pelvic or acetabular fractures remains unclear. We report our experience with surgical treatment of 4patients with acetabular roof column fracture and EIA injury. All the 4 patients underwent injury control resuscitation andsurgery after admission. One patient died of multiple organ dysfunction syndrome (MODS), and the other 3 patientsrecovered smoothly. In these cases, as we presume, the occurrence of acetabular roof column fracture caused the EIA, whichwas connected to the iliopsoas muscle through soft tissues such as the iliac fascia, to be pulled into the fracture space alongwith the iliopsoas muscle and was cut directly by the fracture end; the EIA may also be punctured during transport andfracture reduction. Although acetabular roof column fractures with EIA injuries rarely occur, the consequences can be fatal. Insuch cases, clinicians should be highly vigilant about the possibility of large vessel injuries, and its early detection using threedimensional vascular reconstruction based on CT vessels or arterial interventional angiography can be critical forimplementation of early treatment to save the limbs.