I'm definitely of the "low impact" school of special combat effects. Not so much getting your eye poked out (that's a result for below 0 hit points - another table to work up) or maiming your buddy with a wild swing, but just minor effects that add flavor to the flow of a combat.
When someone rolls a natural 20 to hit in my game, I use the table to help decide what happens. The victim of the hit chooses whether to take maximum damage from the hit, or to roll the damage normally and suffer a random mishap from the table. If the mishap doesn't apply - for example, nothing is carried in a particular hand, or a creature doesn't have a head - then maximum damage has to happen.
As fumbles, the mishaps can also occur on a natural to hit roll 1, for the character who rolled it, but in that case there is no consequence if a particular mishap doesn't apply.
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Right now, breakage tests are ruled according to common sense, but I'm working on a system to handle quick and easy non-living object damage. That and the "death and dismemberment" table I want to use are both coming up.