We congratulate the authors of this excellent combined report. What a pleasure it is to find two surgical specialties cooperating in this way. The working party has carefully analysed the available data, considered the various options for management and proffered clear advice which we hope will be useful for all surgeons managing these difficult injuries. The message of collaboration was conveyed in the first edition of the report. This stressed that, in order to avoid repeated surgery and long term disability, it is necessary to evaluate each injury and to establish communication between the two disciplines as soon as possible, with the aim of providing optimal conditions for wound and fracture healing. The working party feels that this message now needs re-emphasising and it is our hope that this latest report, by up-dating and repeating the principles of management, will lead to a further improvement in outcomes.