Thirty-two patients who had sustained severe fractures of the tibial shaft more than 3 years ago were reviewed. In patients where the limb was preserved, the factors associated with a poor outcome were: (a) an elderly patient; (b) proximal and distal third fractures; (c) extensive soft tissue damage and (d) accompanying multiple injuries. Twelve patients underwent immediate amputation. The disability resulting from amputation was high and therefore did not justify recommending earlier amputation even when it was thought that it might be needed later. Whether the limb was preserved or not, the social cost of the injury was high; amputation did not affect the patient's chances of returning to work.