BACKGROUND: Open pelvic fracture is a rare injury. Our aim in this study is to systematically review the literature to define when diverting colostomy is indicated to protect the patient from infection in open blunt pelvic fractures. METHODS: Papers studying open pelvic fractures and the use of colostomy were retrieved through MEDLINE and PUBMED. The papers were critically appraised regarding their methodology and conclusions. Relevant information was combined. RESULTS: The level of evidence for the use of colostomy in open pelvic fractures is very low. All reports are retrospective and no statistical methods have been used to support conclusions drawn. We found no difference in the overall infectious complication rate between the colostomy and noncolostomy groups. There is an assumption that patients with perineal wounds would benefit from colostomy; however, rectal involvement in these injuries was not detailed. CONCLUSION: The role of colostomy in open blunt pelvic fractures is unresolved and randomized multicenter trials are needed.