Multi-casualty events are characterized by a large number of wounded people arriving at trauma centers in a short period of time. These wounded suffer distinctive injuries in accordance with the cause of the event. Close to 50 percent of all injuries in a multi-casualty event are musculoskeletal injuries. These injuries are not usually isolated and indicate that the patient has suffered severe trauma. Correct management of such an event requires proper management in the pre-hospital, trauma centers, wards and operating galleries. A "damage control" policy should be implemented in all stages of the patient's care. Orthopedic care has been revolutionized several times--developing from delayed care, to early total care and finally to "damage control" orthopedics. "Damage control" orthopedics emphasizes initial stabilization and control of injuries, due to the systemic cytokine storm after polytrauma, prior to final corrective surgery of the patient's fractures. In this article the authors review the orthopedic care in a multi-casualty event, and the specific care given to each of the wounded in such an event.