We reviewed 233 traumatic injuries to the liver. The mortality was 11%. Deaths were due to either uncontrolled intraoperative hemorrhage or the postoperative complications of multiple organ injuries. The majority of liver injuries can be safely managed with manual compression, porta hepatic control, simple sutures, or drainage. Liver injuries involving the hepatic veins or retrohepatic vena cava continue to be highly lethal despite the use of vascular isolation and hepatic resection.