In this retrospective review of 37 patients with combined orthopedic and vascular injuries, our management strategy emphasized the prompt recognition of limb threat. Twenty-two patients had lower-extremity and 15 had upper-extremity injuries. No deaths occurred. Five delayed amputations were performed for limbs left denervated by associated soft tissue or neural injuries. No late vascular insufficiency was recorded in patients who underwent reconstruction with autogenous tissue. Whenever possible, the precise site of vascular injury was identified angiographically to help plan an approach that would provide adequate exposure for vessel repair as well as orthopedic stabilization. Vascular reconstruction typically preceded osseous stabilization. We conclude that improved outcome requires a coordinated multidisciplinary approach, expeditious limb revascularization, fasciotomy as indicated, rapid fixation of osseous injuries, and adequate soft tissue coverage of the underlying repair.