The application of a pelvic external fixator can be a vital stage in the management of patients with severe pelvic fractures, either as part of the resuscitation phase or as definitive treatment. This paper shows the complication rate of pelvic external fixation to be 47 per cent. This high rate increases the morbidity associated with the fracture, and may also interfere with the definitive management. The majority of complications were associated with pin placement and the pin-bone interface. An understanding of the principles of external fixation and knowledge of the correct methods of application should reduce this complication rate.