Background Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation (ORIF).This often leads to pelvic malunion in patients with unstable pelvic fracture,shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics.This study explored the role of early external fixation (within 7 days) for patients with unstable pelvic fractures.Methods A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 (file type B:18 cases; C:14 cases).The study comprised 28 males and 4 females,with a mean age of (32±8) years (range,21-56 years).Of these patients,22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days.Fifteen cases suffered traumatic hemorrhagic shock.A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998.Results The average follow-up was (34.7±14.6) months (range,6-66 months).Six to eight weeks after external fixation,patients could walk with crutches; by 12 weeks,external fixation was removed and all fractures had healed.Seven patients presented with sequelae,including 3 patients with long-term lumbosacral pain,3 patients with erectile dysfunction and 1 patient with Morel-Lavallee lesion and other complications.The 15 shock patients in this study (2005-2010 group) required significantly lower volumes of fluid infusion and blood transfusion (Pfluid=0.000;Ptransfusion=0.000) as compared to the 1993-1998 cohort.Conclusions The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability,with outstanding efficacy as a final fixation option for unstable pelvic fractures.