SummaryThe emergency treatment of pelvic ring injuries is dictated by the amount of pelvis instability, the presence of associated injuries, and the patient’s condition. In this respect, timing is everything, and therefore a comprehensive protocol for the acute treatment of pelvis fractures is mandatory. The initial evaluation of the patient should follow the Advanced Trauma Life Support (ATLS) standards. As part of the initial assessment, pelvis instability should be identified and the diagnosis of a pelvic fracture can then be confirmed on a plain anteroposterior radiograph of the pelvis. Most displaced pelvis fracture should be stabilized immediately. If the patient is hemodynamically stable, a more definitive type of fixation may be performed initially. External fixation is particularly useful in cases of anterior pelvic instability, open fractures of the anterior pelvis, pelvis fractures associated with polytrauma, especially intra-abdominal injuries requiring open exploration, and as the initial stabilization tool of a staged method for definitive pelvis fixation. In this latter scenario, external fixation may be a life saving procedure by closing down and reducing the pelvic fracture and the anatomy of the retroperitoneum, thus creating a tamponade effect on small caliber bleeding vessels.3,5,13,17,22,27,29,33,36Contraindications for external fixation include pelvic fractures through the iliac wing or those fractures associated with fractures of the acetabulum that need open reconstruction. A relative contraindication is a pure vertical displacement of both SI joints. External fixation is not the best means of definitive fixation for posterior unstable fractures of the pelvis, especially those with vertical translation. The purpose of this article is to familiarize the reader with external fixation of the pelvis while reviewing indications, tips, advantages, and disadvantages of this technique.