The association of a major vascular injury with a closed extremity fracture in the pediatric patient is uncommon. The present study of seven such patients includes five fractures treated by open reduction and internal fixation (ORIF) prior to vascular reconstruction. Two were treated in skeletal traction without vascular reconstruction. Most vascular injuries were not diagnosed initially, consequently delaying repair. Early follow-up examination revealed the following complications: wound infections, below-knee amputation, deep vein thrombosis (DVT), and motor and sensory deficits. All of the fractures healed. Late follow-up examinations revealed two cases of overgrowth and one of limb undergrowth. Minor motor and sensory deficits were present, but overall function was good. Arteriography should be performed prior to surgical repair. Because of problems with growth disturbance that require long-term follow-up evaluation, all major vascular injuries should be repaired despite adequate collateral circulation to keep the limb viable. Prompt, accurate diagnosis followed by surgical repair will improve the long-term results.