Aims: The purpose of this study was to investigate the number and type of complications following external þxation of pelvic fractures. Methods: We carried out a retrospective review of all patients treated at Frenchay Hospital with external þxation for fractures of the pelvic ring between August 1996 and September 2002. Patientsñ details were collected prospectively; outcome data was collected by casenote review. Results: 74 patients were treated with external þxation for pelvic fractures. In 41 patients, the þxator was used to achieve pelvic stability temporarily, whilst in 33 it was retained as part or all of the deþnitive treatment. 30 patients were haemodynamically unstable when the þxator was applied. Of these patients, two patients died of retroperitoneal haemorrhage, three had pelvic angiography and arterial embolisation and þve required a laparotomy, of which three were negative. Of the þxators used temporarily, four (10%) had pin-site infections. In only one case did this change the plan for the deþnitive treatment. Two of the temporary þxators required revision; one for loss of reduction secondary to pin loosening and one for pin penetration of the femoral head after using the low anterior approach. Six (8%) of all the þxators required repositioning due to impingement on the skin. Of the deþnitive þxators, 53% required antibiotics and 18% required pin removal for sepsis. Three (9%) of the deþnitive þxators required revision; there was one loss of reduction, one re-displacement after removal and one non-union of the pelvic fractures. Conclusions: Temporary application of external þxation to the fractured pelvis, using high iliac crest pin placement to restore pelvic stability, is a safe procedure with few complications. Haemodynamic stability is restored in the majority of patients. When used as part of the deþnitive treatment, pin site infection is common and may require pin removal but rarely leads to loss of fracture reduction or revision of þxation.