In the literature it has been unanimously reported that here is a heavy burden on operative disciplines due to the occurrence of complications and the commonly resulting accusation of an error in treatment. Most of these accusations affect the discipline of surgery and in the main aspects trauma surgery is disproportionally represented. This substantial burden and high rate of accusations against trauma surgery arises from the high transparency as complications in trauma surgery are visualizable. Dealing with complications is therefore an elementary function of trauma surgeons. The analysis of postoperative complications shows clearly that in most cases they do not only result from the postoperative course. The causes of postoperative complications in many cases are more likely to have already begun in the pre-operative and peri-operative phases. Pre-existing diseases and risk factors as well as operation planning and establishing indication status are in many cases the pre-operative and intra-operative origins of postoperative complications. In the present article the authors attempt to address the issues of new aspects of complications and therefore the quality management of trauma surgery, without making claim to completeness.