Until recently, the fracture was regarded as the dominant element of high energy injuries, probably because trauma and orthopedic training was, by tradition, centered on the care of bone and joint injuries. Nowadays, however, orthopedic and trauma surgeons consider soft tissue injuries to be the most important component of high-energy trauma. High energy injuries such as polytrauma that may lead to dysfunction or failure of remote organs and vital systems, open fractures indicating a communication between the fracture and the external environment, pelvic fractures comprised of pelvic ring injuries and acetabular fractures are mostly associated with soft tissue injuries and are different from low energy injuries in their mechanism. Treatments of high energy injuries are more difficult than those of low energy injuries. Meticulous care should be taken to evaluate complications such as compartment syndrome, deep vein thrombosis, pulmonary embolism, and fat embolism, which tend to be easily neglected. Fractures with soft tissue injuries that are mostly high energy injuries need focusing on the patient as a whole and comprehensive approach. Close observations to establish early diagnosis of complications and to take timely, appropriate measures are also necessary.