The orthopedic surgeon has little evidence-based literature to refer to when deciding when a patient is "safe" to drive a car. Current advice is derived from several empirical reports on soft-tissue and bone healing. Using the terms surgery and driving, I searched Pubmed and Medline to review the relevant English-language research literature published between 1960 and the present. Of the 975 studies found and examined--all studies, surveys, and case reports involving the extremities were considered--35 had orthopedic relevance. Recommendations for return to driving are presented here. Orthopedic surgeons should find this review an aid when they use the literature to make informed decisions about patients' return to driving and when they conduct further evidence-based investigation to determine orthopedic fitness to drive.