Thirty-one of 738 patients with pelvic fracture (1970--1978) had open pelvic fractures. Eight per cent of all pelvic fractures due to pedestrian accidents and 12.5% due to motorcycle accidents were open. The mortality for open pelvic fractures was 42% compared with 10.3% for closed pelvic fractures. The open pelvic fracture was the primary or an important secondary cause of death in 85% of patients who died. Major causes of death related to open pelvic fracture are (1) hemorrhage and (2) sepsis and/or renal failure. Major vascular injury is common with open pelvic fracture (19%) and compounds the problem of blood loss. Therapy is directed to blood volume replacement, repair of major vascular injury and to control of diffuse retroperitoneal hemorrhage. Any drainage should be by a closed system. This procedure plus colostomy with perineal, vaginal or rectal injury should decrease septic complications. The high mortality reflects the inadequacy of current methods of treatment of open pelvic fractures.