The mangled extremity is a complex and multifaceted traumatic orthopaedic injury. This injury results in damage to bone, nerve, soft tissue, and/or vascular structures, and often requires multiple surgeries. The treatment decision between limb salvage and amputation is complicated, but must be made. A systematic approach to the evaluation and medical decision-making process can help an orthopaedic provider to make an informed medical decision. This article will provide a detailed overview of the evaluation, medical decision-making, and treatment of the mangled extremity.