Background <p>Hemodynamically unstable pelvic ring injuries pose significant challenges in trauma care. Although external fixation is traditionally used for initial stabilization, pelvic binders have emerged as potential alternatives. Therefore, this study aimed to evaluate the feasibility and safety of maintaining pelvic binders alone as a temporary stabilization method in patients with hemodynamically unstable pelvic ring injuries.</p> Methods <p>This retrospective cohort study included 114 patients with hemodynamically unstable pelvic ring injuries treated at two Level 1 trauma centers. The patients were divided into two groups: Binder-Only (<i>n</i> = 53) and External Fixation (<i>n</i> = 61). Outcomes including complications, intensive care unit (ICU) length of stay, and mechanical ventilation duration were compared.</p> Results <p>Baseline characteristics and injury severity were comparable between the two groups. There were no significant differences in complication rates (22.6% vs. 26.2%, <i>p</i> = 0.657), ICU length of stay (8 [3–16] vs. 10 [6–19] days, <i>p</i> = 0.257), or mechanical ventilation duration (3 [1–6] vs. 5 [2–9] days, <i>p</i> = 0.098) between the Binder-Only and External Fixation groups. The Binder-Only group achieved anterior fixation earlier than the External Fixation group (2 [1–2] vs. 4 [2–5] days, <i>p</i> &lt; 0.001). Logistic regression analysis confirmed that group allocation was not associated with complications. The independent predictors of complications included diabetes mellitus, initial lactate level, and packed red blood cells transfusion within 4&#xa0;h.</p> Conclusions <p>Pelvic binders provide sufficient temporary stabilization in hemodynamically unstable pelvic ring injuries, with outcomes comparable to those of external fixation. This strategy offers a practical alternative that avoids the complications and logistical challenges associated with external fixation.</p>