Critical analysis of 53 cases of Malgaigne fracture of the pelvis was undertaken at Hennepin County Medical Center, Minneapolis, over a 10-year period (1968-1978) with particular emphasis to immediate and late complications. Thirty patients were followed from 2 to 12 years after injury. Eleven patients were asymptomatic. Eleven had paresthesias of the lower extremity on the same side as the fracture. Nine had gait disturbance, eight had severe low back pain, four had groin pain, and two had fecal incontinence. Low back pain as a late sequela was related to sacral or sacroiliac injury. There appeared to be a correlation between the amount of displacement of the detached hemipelvis and the frequency of subsequent low back pain. Reduction of the upward displacement of the hemipelvis, by whatever means, to anatomic configuration can be of help in reducing late sequelae. In the later years of this study external fixation was successful.