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Gerhard M. Hobusch Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria

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Kevin Döring Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria

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Rickard Brånemark Gothenburg University, Gothenburg, Sweden
Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

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Reinhard Windhager Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria

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traumatic lower-limb amputees need to have revision surgery, 5 and 25–56% of amputees develop social problems. Age-adjusted rates of lower-extremity amputations are in the range of 16.9–22.9 amputees/100,000 inhabitants/year in different countries

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Abdel Rahim Elniel Leeds Teaching Hospitals Trust, UK

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Peter V. Giannoudis Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, UK

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and burning sensations. Amputation Primary amputation may be considered in cases of uncontrollable haemorrhage, prolonged crush injury, an avascular limb or segmental bone/muscle loss. The decision is not taken lightly and should be discussed

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Josep Muñoz Vives Hospital Nostra Senyora de Meritxell, Andorra, Spain

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Jean-Christophe Bel Hospices Civils de Lyon, Lyon, France

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Arantxa Capel Agundez Hospital Universitario 12 de Octubre, Madrid, Spain

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Francisco Chana Rodríguez Hospital General Universitario Gregorio Marañón, Madrid, Spain

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José Palomo Traver Hospital General de Castelló, Castelló de la Plana, Spain

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Morten Schultz-Larsen Odense Universitetshospita, Odense, Denmark

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Theodoros Tosounidis Leeds General Infirmary, Leeds, UK

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69% of the cases. 2 Associated fractures can be present in 44% of patients. 9 The death rate on admission can be up to 10%. 10 - 12 Popliteal artery lesions and/or severe open fractures and mangled limbs can lead to amputation in 9

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Mehnoor Khaliq Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Vasileios P Giannoudis Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Jeya Palan Leeds Teaching Hospitals NHS Trust, Leeds, England

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Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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Bernard H van Duren Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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. Any discrepancies between the investigators (MK/VG) were referred to a third investigator for arbitration (BvD). Full texts of articles meeting the inclusion criteria were obtained. All studies related to limb amputation in the upper/lower extremity

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Cora Rebecca Schindler Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Ramona Sturm Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Jason Alexander Hörauf Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Ingo Marzi Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Philipp Störmann Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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the decision-making ( 14 , 16 ). The decision to amputate or to preserve the limb in cases of severe injury should be made as an individual decision. In rare cases and in extremely severe injuries, amputation may be recommended ( 33 ). In addition

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Logan Petit Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

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Theodore Zaki Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA

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Walter Hsiang Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

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Michael P. Leslie Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

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Daniel H. Wiznia Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

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Motorcycle thumb Collision Pelvic ring Fuel tank injuries Collision Lower extremity: femur, tibia, fibula Limb entrapment Lowside Lower extremity: heel Tyre-spoke injury Lowside Lower extremity: foot Crash modifying

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Mario Herrera-Pérez Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain

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Pablo Martín-Vélez Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain

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David González-Martín Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain

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Miguel Domínguez-Meléndez Foot and Ankle Unit, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain

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Ahmed E Galhoum Specialty Doctor Trauma and Orthopaedics, George Eliot Hospital NHS Trust, Nuneaton, UK

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Victor Valderrabano Schmerzklinik, Basel, Switzerland
University of Basel, Basel, Switzerland

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Sergio Tejero Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
School of Medicine, Universidad de Sevilla, Sevilla, Spain

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preference. AKA, above-knee amputation; ASA, Functional score from the American Society of Anaesthesiology; BKA, below-knee amputation; DVT, deep vein thrombosis; FU, follow-up; LOE, level of evidence; Nr, non reported; NWB, Non-weight-bearing; ORIF

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Elizabeth K Tissingh The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
King’s Global Health Partnerships, School of Life Course and Population Sciences, King’s College London, London, UK

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Leonard Marais Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa

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Antonio Loro Comprehensive Rehabilitation Services for People with Disability in Uganda (CoRSU) Hospital, Kisubi, Uganda

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Deepa Bose University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

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Nilo T Paner Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines

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Jamie Ferguson The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines

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Mario Morgensten Centre for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland

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Martin McNally The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

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include internal and external fixation for fractures (open or closed) and amputation ( 8 ). Injuries cause more than 5 million deaths per year ( 9 ) and it is estimated that 88% of injury-related deaths occur in LMICs ( 10 ). For every death, between 10

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Hagen Schmal Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
Department of Orthopaedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.

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Michael Brix Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.

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Mats Bue Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark

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Anna Ekman Orthopaedic Department, Södersjukhuset, Stockholm, Sweden

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Nando Ferreira Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa

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Hans Gottlieb Department of Orthopaedic Surgery, Herlev Hospital, Herlev, Denmark

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Søren Kold Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg University, Aalborg, Denmark

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Andrew Taylor Department of Orthopaedic Surgery, Nottingham University Hospitals, UK

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Peter Toft Tengberg Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

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Ilija Ban Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

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Danish Orthopaedic Trauma Society Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

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swelling, and improvement of function. For a minority of patients this might mean that an amputation or a ‘stable’ nonunion with acceptable pain level might be an option. For most patients an operative revision is indicated and required when progress in

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Karl Stoffel Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland

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Christoph Sommer Department of Surgery, Kantonsspital Graubuenden, Chur, Switzerland

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Mark Lee Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California, USA

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Tracy Y Zhu AO Innovation Translation Center, AO Foundation, Davos, Switzerland

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Karsten Schwieger AO Innovation Translation Center, AO Foundation, Davos, Switzerland

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Christopher Finkemeier Sutter Roseville Medical Center, Roseville, California, USA

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screw breakage or cutout; 2 superficial wound infection; 1 deep vein thrombosis Swentik et al. (25) 8/10 (80%) (excluding the one with knee amputation) patients had healed fracture without repeated operations; 1 required revision stabilization

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