Introduction: Injuries inflicted by motorboat propellers are rare but often result in extensive soft tissue and osseous injuries and can have great impact on the functional outcome of the patient. Treatment is challenging and needs a multidisciplinary approach. Methods: This study retrospectively analyzed 4 cases and performed a PubMed, Embase, Medline and Cochrane literature search. All articles presenting original patient data were included. Results: In all four cases, a multidisciplinary approach was used. Mean follow up was 15.8 months (range 6 to 35). All patients had some degree of functional impairment with lower Foot and Ankle Outcome Score (FAOS) concerning sport and recreation, and foot- and ankle-related quality of life. A review of the literature revealed 20 articles with 95 reported cases. The most common injury was to the lower extremities (63 limbs). The injury mechanism was available for 84 cases; 62% was water sport related. In 18 cases, the propeller injury resulted in an amputation of the a ected extremity. Twenty fatalities could be identified. Conclusions: Motorboat propeller injuries can be severe and even fatal. Lower extremities are particularly at risk, resulting inex-tensive soft tissue and osseous injuries with a significant risk of subsequent amputation. The impact on functional outcome can be significant. A patient-based and multidisciplinary approach is necessary to ensure an optimal outcome.