Ten patients with 12 severe limb injuries managed by external skeletal fixation over 2 years are presented. Two major indications for external skeletal fixation divided the fractures into groups: A) extensively open fractures requiring wound care and closure by other than primary methods, and B) grossly unstable fractures requiring stabilization for soft-tissue support and fracture alignment. Group A was composed of five extremity fractures with skin and muscle loss and deep tissue contamination. Wound management was the primary problem. Wound closure, prevention of an infection, and limb salvage were the treatment goals in this group. Group B was seven severely comminuted extremity fractures with significant swelling and in some cases, questionable soft-tissue survival. Five were open, but not extensively. Instability was the primary problem. Fracture control, soft-tissue support, and limb salvage were the treatment goals in this group. Mean followup period for all fractures was 9.4 months. No amputations, deep infections, or deaths resulted. Wound care and closure were facilitated in all open fractures. Loss of contused tissues with marginal vascular supply was felt to be minimized. Delayed unions were common in both groups. Two malunions and one nonunion occurred. Treatment goals in both groups were accomplished.