War wounds are often large and complex, with high degrees of contamination and tissue loss differing significantly from typical civilian injuries. Infection has been a common complication driving the tenets of care, even in the antibiotic age. Fractures were historically treated with casting or traction because of the risk of infection with internal fixation. However, current civilian fracture care has evolved significantly with extensive use of internal and external fixation with early mobilization and other adjuncts to restore function earlier and more completely. Whether the application of modern techniques and implants can better restore function in patients with these severe injuries is currently being evaluated.