With the trend toward reconstructive vascular surgery, this paper discusses the practicability of blood-vessel repairs in the presence of orthopaedic injuries. The incidence of vascular injuries in the presence of fractures is noted as varying from 10 per cent in civilian injuries to 56 per cent in one group of battlefield injuries. The complications of vascular injuries are presented and their prevention discussed. Operative care of acute vascular injuries and pulsating hematomata should be reconstructive rather than obliterative. It is pointed out that there are still indications for ligation of major vessels. While ligation of an artery feeding a pulsating hematoma is safer than ligation of an acutely injured artery, a high degree of functional vascular insufficiency may result. Care of the injured vessel in the presence of fracture is discussed stressing reconstructive vascular surgery.