Dorsal shearing injuries of the hand and wrist can be seen with high-energy motor vehicle accidents and present challenging problems to the reconstructive surgeon. At the time of initial injury, care must be taken to adequately debride the mangled extremity and extensive wounds. Following debridement, a series of decisions must be made regarding bony stabilization, extensor tendon reconstruction, and soft tissue coverage. These reconstructions often require staged procedures, and appropriate planning is warranted from the start. Reasonable function of the hand can be expected from the patient following such injuries.