Rarely in D&D do we keep track of where our character is wounded. When he gets hit we just record damage and move on. In order for combat to run smoothly this is a compromise we’ve accepted from day one. Until you PC falls below 0 hit points you just assume he’s got full control over his entire body.
Last week I broke my arm and it got me thinking about how to introduce a system into 4e D&D that represented damage to specific areas of the body. The real trick was to do it in a way that actually added value to the game without just slowing things down or adding unnecessary new rules.
The way I see it, tracking specific damage can be handled in one of two ways: 1) strictly from a role-play perspective; or 2) as an actual mechanic that affects the numbers.