Objective To discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P < 0. 05) . However, the units of RBC transfusion significantly decreased( P <0.05) and there were no significant difference in pulse rate( P > 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality.