Supplement to the Clinical Practice Guideline for Limb

SUPPLEMENT TO THE CLINICAL PRACTICE GUIDELINE FOR LIMB SALVAGE OR EARLY AMPUTATION e-Appendix • Quality Evaluation • Data Summary • Detailed Data Tables • Excluded Literature • AAOS Approval Bodies Table of Contents Quality Evaluations ...... 3 Section 1. Smoking-Drugs-Alcohol ...... 6 Section 2. Poly-trauma ...... 14 PICO 1 ...... 14 PICO 2 ...... 15 Section 3.1. Psychological Factors ...... 26 Section 3.2. Psychosocial Support ...... 38 Section 4. Rehabilitation ...... 41 Section 5. Health Scores ...... 52 PICO 1 ...... 52 PICO2 ...... 53 Section 6. Insensate/Nerve Injury ...... 63 Section 7. Crushed/Blunt Injury ...... 69 Section 8. Physiologic Viability ...... 70 PICO 1 ...... 70 PICO 2 ...... 71 Section 9. Comorbidities ...... 72 Section 10. Vascular Injury ...... 78 Section 11. Injury Type ...... 80 Section 12. Amputation/Salvage ...... 83 Section 13. Degloving ...... 88 Section 14. Operative Complications ...... 89 Section 15. Prosthesis ...... 90 Section 16. Segmental Bone Loss...... 95 Section 17. Volumetric Muscle Loss ...... 96 Excluded Literature ...... 98 AAOS CPG Approval Bodies ...... 187

Quality Evaluations

Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis

MacKenzie, E. J.,

High Quality 2006

O'Toole, R. V.,

High Quality 2008

Allami, M., 2017 Moderate Quality

Archer, K. R., 2010 Moderate Quality

Bennett, P. M.,

Moderate Quality 2017

Bosse, M. J., 2005 Moderate Quality

Castillo, R. C.,

Moderate Quality 2008

Ly, T. V., 2008 Moderate Quality

MacKenzie, E. J.,

Moderate Quality 2004

Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis

MacKenzie, E. J.,

Moderate Quality 2005

Masoumi, M.,

Moderate Quality 2014

Pezzin, L. E., 2000 Moderate Quality

Almassi, F., 2010 Low Quality

Asensio, J. A.,

Low Quality 2006

Aydemir, K., 2017 Low Quality

Bennett, P. M.,

Low Quality 2018

Blair, J. A., 2014 Low Quality

Bosse, M. J., 2002 Low Quality

Burns, T. C., 2012 Low Quality

Doucet, J. J., 2011 Low Quality

Dickens, J. F., 2013 Low Quality

Ellington, J. K.,

Low Quality 2013

Gailey, R., 2010 Low Quality

Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis

Gaunaurd, I. A.,

Low Quality 2013

Gunawardena, N.,

Low Quality 2007

Hutchison, T. N.,

Low Quality 2014

Jain, A., 2013 Low Quality

Laferrier, J. Z.,

Low Quality 2010

Low, E. E., 2017 Low Quality

Melcer, T., 2013 Low Quality

Melcer, T., 2017 Low Quality

Melton, S. M.,

Low Quality 1997

Stranix, J. T., 2017 Low Quality

Webster, C. E.,

Low Quality 2018

Wen, P. S., 2018 Low Quality

Working, Z. M.,

Low Quality 2017

Section 1. Smoking-Drugs-Alcohol Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx time since injury, summary score, treatment, complication, <10 education, Cigarettes pts w/ severe income, race, Multivariate /day leg injuries insurance, Logistic increases resulting in smoking, self- regression, the odds reconstructio Sickness <10 efficacy, social percent of a worse Bosse, M. Low n or impact Smoking/Dr Cigarettes/d 24 support, lawyer difference, 16.6, overall SIP J., 2002 Quality amputation. Profile (SIP) ugs/Alcohol ay 460 mon. hired p-value P<0.05 score time since injury, summary score, treatment, <10 complication, Cigarettes education, /day pts w/ severe Sickness income, race, Multivariate increases leg injuries Impact insurance, Logistic the odds resulting in Profile smoking, self- regression, of a worse reconstructio (Physical <10 efficacy, social percent physical Bosse, M. Low n or function Smoking/Dr Cigarettes/d 24 support, lawyer difference, 16.2, function J., 2002 Quality amputation. score) ugs/Alcohol ay 460 mon. hired p-value P<0.05 score time since injury, summary score, treatment, pts w/ severe Sickness complication, leg injuries Impact education, Multivariate resulting in Profile income, race, Logistic reconstructio (Psychosoci <10 insurance, regression, Bosse, M. Low n or al function Smoking/Dr Cigarettes/d 24 smoking, self- percent Not J., 2002 Quality amputation. score) ugs/Alcohol ay 460 mon. efficacy, social difference 17 Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx support, lawyer hired time since injury, summary score, treatment, complication, >=10 education, Cigarettes pts w/ severe income, race, Multivariate /day leg injuries insurance, Logistic increases resulting in smoking, self- regression, the odds reconstructio Sickness >=10 efficacy, social percent of a worse Bosse, M. Low n or impact Smoking/Dr Cigarettes/d 24 support, lawyer difference, 24.1, overall SIP J., 2002 Quality amputation. Profile (SIP) ugs/Alcohol ay 460 mon. hired p-value P<0.01 score time since injury, summary score, >=10 treatment, Cigarettes complication, /day education, increases pts w/ severe Sickness income, race, Multivariate the odds leg injuries Impact insurance, Logistic of a worse resulting in Profile smoking, self- regression, psychosoc reconstructio (Psychosoci >=10 efficacy, social percent ial Bosse, M. Low n or al function Smoking/Dr Cigarettes/d 24 support, lawyer difference, 36, function J., 2002 Quality amputation. score) ugs/Alcohol ay 460 mon. hired p-value P<0.05 score time since injury, summary >=10 score, Cigarettes treatment, /day pts w/ severe Sickness complication, Multivariate increases leg injuries Impact education, Logistic the odds resulting in Profile income, race, regression, of a worse reconstructio (Physical >=10 insurance, percent physical Bosse, M. Low n or function Smoking/Dr Cigarettes/d 24 smoking, self- difference, 27.9, function J., 2002 Quality amputation. score) ugs/Alcohol ay 460 mon. efficacy, social p-value P<0.05 score

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx support, lawyer hired Treatment, age, gender, race, Current education, smokers poverty status, are at smoking status, increased legal odds of a LEAP Study involvement, Multivariate higher SIP patients; Physical SIP self-efficacy, Logistic than MacKenzie Mod. Unilateral Sub-score of Smoking/Dr Current 84 probability of Regression; 2.1, never , E. J., 2005 Quality injuries only. >=5 points ugs/Alcohol smoker 397 mon. amputation OR, p-value <0.01 smokers Treatment, age, gender, race, Current education, smokers poverty status, are at smoking status, increased legal odds of a LEAP Study involvement, Multivariate higher SIP patients; Physical SIP self-efficacy, Logistic than MacKenzie Mod. Unilateral Sub-score of Smoking/Dr Current 84 probability of Regression; 3.3, never , E. J., 2005 Quality injuries only. >=20 points ugs/Alcohol smoker 397 mon. amputation OR, p-value <0.01 smokers Current Treatment, age, smokers gender, race, are at education, increased poverty status, odds of a smoking status, higher legal psychosoc LEAP Study Psychosocial involvement, Multivariate ial SIP patients; SIP Sub- self-efficacy, Logistic than MacKenzie Mod. Unilateral score of >=5 Smoking/Dr Current 84 probability of Regression; 1.7, never , E. J., 2005 Quality injuries only. points ugs/Alcohol smoker 397 mon. amputation OR, p-value <0.05 smokers Treatment, age, Current MacKenzie Mod. LEAP Study Psychosocial Smoking/Dr Current 84 gender, race, Multivariate 1.8, smokers , E. J., 2005 Quality patients; SIP Sub- ugs/Alcohol smoker 397 mon. education, Logistic <0.05 are at

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Unilateral score of poverty status, Regression; increased injuries only. >=20 points smoking status, OR, p-value odds of a legal higher involvement, psychosoc self-efficacy, ial SIP probability of than amputation never smokers Treatment, age, gender, race, recent education, smokers poverty status, are at smoking status, increased legal odds of a LEAP Study involvement, Multivariate higher SIP patients; Physical SIP self-efficacy, Logistic than MacKenzie Mod. Unilateral Sub-score of Smoking/Dr Quit 84 probability of Regression; 2.1, never , E. J., 2005 Quality injuries only. >=5 points ugs/Alcohol smoking 397 mon. amputation OR, p-value <0.01 smokers Treatment, age, gender, race, recent education, smokers poverty status, are at smoking status, increased legal odds of a LEAP Study involvement, Multivariate higher SIP patients; Physical SIP self-efficacy, Logistic than MacKenzie Mod. Unilateral Sub-score of Smoking/Dr Quit 84 probability of Regression; 2.2, never , E. J., 2005 Quality injuries only. >=20 points ugs/Alcohol smoking 397 mon. amputation OR, p-value <0.01 smokers Treatment, age, Smokers gender, race, who quit education, are at poverty status, increased LEAP Study Psychosocial smoking status, Multivariate odds of a patients; SIP Sub- legal Logistic higher MacKenzie Mod. Unilateral score of >=5 Smoking/Dr Quit 84 involvement, Regression; 2.3, psychosoc , E. J., 2005 Quality injuries only. points ugs/Alcohol smoking 397 mon. self-efficacy, OR, p-value <0.01 ial SIP

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx probability of than amputation never smokers Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study Psychosocial involvement, Multivariate patients; SIP Sub- self-efficacy, Logistic MacKenzie Mod. Unilateral score of Smoking/Dr Quit 84 probability of Regression; 1.3, , E. J., 2005 Quality injuries only. >=20 points ugs/Alcohol smoking 397 mon. amputation OR, p-value <0.10 >1 debridement, amputation>5 days post injury, ischaemic vascular injury/multi- planar degloving, above-knee Multivariate pts w/ non- amputation, Logistic salvageable Infection in tertiary referral, Regression, 1.8 (0.5- Jain, A., Low lower limb Residual Smoking/Dr smoker, OR, CI, p- 7.1), Not 2013 Quality injuries Limb ugs/Alcohol Smoker 40 diabetes value >0.05 Significant level of amputation, All pts age, education, unilateral insurance, lower limb income, Multivariate Smoking amputation, smoking status, Logistic results in most injuries Overall chronic medical regression, increased from motor Sickness conditions, percent odds of MacKenzie Mod. vehicle impact Smoking/Dr injury severity difference, 32.3, overall SIP , E. J., 2004 Quality accident Profile (SIP) ugs/Alcohol Smoking 124 score, ipsilateral p-value 0.02 score

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury, self- efficacy level of amputation, age, education, insurance, All pts income, unilateral smoking status, Smoking lower limb chronic medical Multivariate results in amputation, conditions, Logistic increased most injuries injury severity regression, odds of from motor Physical score, ipsilateral percent physical MacKenzie Mod. vehicle Function of Smoking/Dr injury, self- difference, 31.9, function , E. J., 2004 Quality accident SIP ugs/Alcohol Smoking 124 efficacy p-value 0.02 SIP score level of amputation, age, education, insurance, All pts income, Smoking unilateral smoking status, results in lower limb chronic medical Multivariate increased amputation, conditions, Logistic odds of most injuries injury severity regression, psychosoc from motor Psychosocial score, ipsilateral percent ial MacKenzie Mod. vehicle Function of Smoking/Dr injury, self- difference, 53.4, function , E. J., 2004 Quality accident SIP ugs/Alcohol Smoking 124 efficacy p-value 0.001 SIP score level of amputation, All pts age, education, unilateral insurance, lower limb income, amputation, smoking status, most injuries chronic medical Multivariate from motor Walking conditions, Logistic MacKenzie Mod. vehicle speed (>=4 Smoking/Dr injury severity regression, 0.37, Not , E. J., 2004 Quality accident ft/sec) ugs/Alcohol Smoking 124 score, ipsilateral OR, p-value 0.11 Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury, self- efficacy P-amp score, treatment, age, gender, race, education, smoking status, invovment w/ LEAP Data; legal system, Unilateral self efficacy, job injuries; tenure, job motor involvement, 3- Proportional vehicle month VAS pain, Hazards 1.42 primary Smoking 3-month regression, (0.96- MacKenzie High mechanism Return to Smoking/Dr Status (quit 84 physical SIP RR, CI, p- 2.11), Not , E. J., 2006 Quality of injury Work (RTW) ugs/Alcohol smoking) 423 mon. score value p<0.1 Significant P-amp score, treatment, age, gender, race, education, smoking status, invovment w/ LEAP Data; legal system, Unilateral self efficacy, job Those injuries; tenure, job who never motor involvement, 3- Proportional smoked vehicle Smoking month VAS pain, Hazards 1.87 have an primary Status 3-month regression, (1.29- increase MacKenzie High mechanism Return to Smoking/Dr (never 84 physical SIP RR, CI, p- 2.70), risk of , E. J., 2006 Quality of injury Work (RTW) ugs/Alcohol smoked) 423 mon. score value p<0.01 RTW

Section 2. Poly-trauma PICO 1 Ref. title Quality Patient Outcome RF Type Full RF N Confounding Statistic Result Author Characteristics Title name Adjustment Reported Favored Tx UK military personnel; pelvic fracture, Multivariate Pelvic fracture Associated 3.135 Webster, Low bilateral and Poly- traumatic Logistic was significantly Mortality Pelvic 958 (2.104- C. E., 2018 Quality unilateral trauma amputation level, Regression; associated with Fracture 4.673) amputation avg extremity OR, CI fatality ISS: 26; UK military Those with personnel; Bilateral pelvic fracture, Multivariate bilateral 1.611 Webster, Low bilateral and Poly- extremity traumatic Logistic lower extremity Mortality 958 (1.219- C. E., 2018 Quality unilateral trauma traumatic amputation level, Regression; amputation had 2.129) amputation avg amputation extremity OR, CI higher odds of ISS: 26; fatality

PICO 2 Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx unclear; Minimum of possibly two fractures amputation, # in the of fractures, Multivariate midfoot and gustilo grade, Logistic Working, Low forefoot; avg EQ-5D # of injury Regression; Not Z. M., 2017 Quality age: 35.7 Mobility Poly-trauma fractures 51 mechanism P-value 0.3 Significant Minimum of two fractures amputation, # in the of fractures, Multivariate midfoot and EQ-5D gustilo grade, Logistic Working, Low forefoot; avg Anxiety and # of injury Regression; Not Z. M., 2017 Quality age: 35.7 Depression Poly-trauma fractures 51 mechanism P-value 0.25 Significant Minimum of two fractures amputation, # in the of fractures, Multivariate midfoot and gustilo grade, Linear Working, Low forefoot; avg # of injury Regression; Not Z. M., 2017 Quality age: 35.7 EQ-5D Total Poly-trauma fractures 51 mechanism P-value 0.06 Significant Minimum of two fractures amputation, # in the of fractures, Multivariate midfoot and gustilo grade, Linear Working, Low forefoot; avg # of injury Regression; Not Z. M., 2017 Quality age: 35.7 EQ-5D VAS Poly-trauma fractures 51 mechanism P-value 0.81 Significant Minimum of two fractures amputation, # in the of fractures, Multivariate midfoot and gustilo grade, Logistic Working, Low forefoot; avg EQ-5D Usual # of injury Regression; Not Z. M., 2017 Quality age: 35.7 Activities Poly-trauma fractures 51 mechanism P-value 0.09 Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Minimum of two fractures amputation, # in the of fractures, Multivariate midfoot and EQ-5D Pain gustilo grade, Logistic Working, Low forefoot; avg and # of injury Regression; Not Z. M., 2017 Quality age: 35.7 Discomfort Poly-trauma fractures 51 mechanism P-value 0.46 Significant Additional injuries education, were a employment, Multivariate determina additional linear nt of Veterans injuries, regression; 4.758, poorer Allami, M., Mod. with ankle- Additional hospitalization, Coefficient, 1.196, mental 2017 Quality foot injuries SF-36 MCS Poly-trauma Injuries 1079 ADLs, IADLs SE, P-value <0.001 health Presence age, disability of rate, additional employment, Multivariate injuries is SF-36 additional linear associated Veterans Physical injuries, regression; 3.716, with Allami, M., Mod. with ankle- Component Additional hospitalization, Coefficient, 1.033, poorer 2017 Quality foot injuries Score Poly-trauma injuries 1079 ADLs, IADLs SE, P-value <0.001 PCS scores Age, education, employment status, marital status, other war-related mixture of injuries, history civilian and of military; hospitalization, unilateral hip prosthetic use, disarticulatio Additional side of Multivariate Masoumi, Mod. n; avg age war-related disarticulation, Logistic Not M., 2014 Quality 19.54 SF-36 PCS Poly-trauma injuries 76 sports activities Regression NS Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Age, education, employment status, marital status, other war-related mixture of injuries, history civilian and of military; hospitalization, unilateral hip prosthetic use, disarticulatio Additional side of Multivariate Masoumi, Mod. n; avg age war-related disarticulation, Logistic Not M., 2014 Quality 19.54 SF-36 MCS Poly-trauma injuries 76 sports activities Regression NS Significant bilateral limb loss, multiple limb loss, cumulative trauma disorder, traumatic brain injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality Increasing of life, number of prosthetic combat device injuries is satisfaction and associated OIF/OEF fit, health Multivariate with service Total status, stroke, Logistic higher members w/ number of PTSD, TBI, regression, 1.38 odds of Laferrier, J. Low lower limb Wheelchair combat pantom limb, # OR, CI, p- (1.15- wheelchai Z., 2010 Quality loss use Poly-trauma injuries 226 of surgeries, value 1.65) r use

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx type of prosthetic. bilateral limb loss, multiple limb loss, cumulative trauma disorder, traumatic brain injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, Compared prosthetic to device unilateral satisfaction and lower- fit, health limb loss, status, stroke, bilateral OIF/OEF PTSD, TBI, Multivariate limb loss service pantom limb, # Logistic 29.75 has higher members w/ Bilateral of surgeries, regression, (11.0- odds of Laferrier, J. Low lower limb Wheelchair lower-limb type of OR, CI, p- 80.7), wheelchai Z., 2010 Quality loss use Poly-trauma loss 226 prosthetic. value p<0.001 r use age, sex, race, Compared weight gain, to pain, mental unilateral health, QoL, lower- Vietnam prosthetic Multivariate limb loss, service device Logistic 12.72 bilateral members w/ Bilateral satisfaction, regression, (6.21- limb loss Laferrier, J. Low lower limb Wheelchair lower-limb health status, OR, CI, p- 26.10), has higher Z., 2010 Quality loss use Poly-trauma loss 245 stroke, PTSD, value <0.001 odds of 18

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx TBI, phantom wheelchai limb, # of r use surgeries, type of prosthetic, multiple-limb loss, bilateral limb-loss, comorbidities, ambulatory, highly active open fracture, deep infection, nonoperative management, k- wire fixation, High-energy open reduction military internal fixation, injuries of coexisting tibial Multivariate the ankle and Delayed plafond Logistic -1.019 foot, Amputation Coexisting fracture, Regression; (0.093- Bennett, P. Mod. primarily of injured midfoot coexisting Coefficient, 1.402), Not M., 2017 Quality blast injuries. area Poly-trauma fracture 114 midfoot fracture CI, P-value 0.141 Significant Coexisting talal and Negative calcaneal Bohler's angle, fracture coexisting talal are Military foot and calcaneal Multivariate associated and ankle fracture, Linear with fractures; Coexisting plafond fracture Regression; -12 (- significant median NISS talal and in addition to change in 24.3- - ly lower Bennett, P. Low. score 12 for AAOS F&A calcaneal hindfoot score, CI, P- 2.6), AAOS F&A M., 2018 Quality all groups Score Poly-trauma fracture 77 fracture value 0.026 Scores Bennett, P. Mod. High-energy Delayed Coexisting open fracture, Multivariate 20.083, Not M., 2017 Quality military Amputation Poly-trauma tibial 114 deep infection, Logistic 0.998 Significant 19

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injuries of of injured plafond nonoperative Regression; the ankle and area fracture management, k- Coefficient, foot, wire fixation, P-value primarily open reduction blast injuries. internal fixation, coexisting tibial plafond fracture, coexisting midfoot fracture Negative Bohler's angle, coexisting talal and calcaneal fracture, coexisting plafond Military foot Fracture of fracture, and ankle the mid-foot coexisting mid- fractures; in addition foot fracture, median NISS to a open fracture, Multivariate Bennett, P. Low score 12 for AAOS F&A hindfoot nerve injury, Linear Not M., 2018 Quality all groups Score Poly-trauma fracture 77 vascular injury Regression NS Significant Military- related OEF, blunt amputees; injury, multiple Multiple avg age 23, amputations, Multivariate amputatio IED most transfemoral Logistic 1.67 ns results common Pulmonary amputation, ISS, regression, (1.00- in Hutchison, Low mechanism embolism Multiple abdomen AIS, OR, CI, p- 2.78), increased T. N., 2014 Quality of injury (PE) Poly-trauma amputations 1003 extremity AIS value 0.0482 odds of PE Military- OEF, blunt 2.15 Multiple related Venous injury, multiple Multivariate (1.35- amputatio Hutchison, Low amputees; thromboem Multiple amputations, Logistic 3.42), ns results T. N., 2014 Quality avg age 23, bolism (VTE) Poly-trauma amputations 1003 transfemoral regression, 0.0013 in 20

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx IED most amputation, ISS, OR, CI, p- increased common abdomen AIS, value odds of mechanism extremity AIS, VTE of injury head and neck AIS bilateral limb loss, multiple limb loss, cumulative trauma disorder, traumatic brain injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, prosthetic device satisfaction and fit, health Multiple status, stroke, limb loss OIF/OEF PTSD, TBI, Multivariate results in service pantom limb, # Logistic 16.31 increased members w/ of surgeries, regression, (3.12- odds of Laferrier, J. Low lower limb Wheelchair Multiple- type of OR, CI, p- 85.30), wheelchai Z., 2010 Quality loss use Poly-trauma limb loss 226 prosthetic. value <0.001 r use age, sex, race, Vietnam weight gain, Multivariate Multiple service pain, mental Logistic 14.48 limb loss members w/ health, QoL, regression, (5.46- results in Laferrier, J. Low lower limb Wheelchair Multiple- prosthetic OR, CI, p- 38.46), increased Z., 2010 Quality loss use Poly-trauma limb loss 245 device value <0.001 odds of 21

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx satisfaction, wheelchai health status, r use stroke, PTSD, TBI, phantom limb, # of surgeries, type of prosthetic, multiple-limb loss, bilateral limb-loss, comorbidities, ambulatory, highly active Tibial plafond fracture in Negative addition Bohler's angle, to coexisting talal hindfoot Military foot Tibial and calcaneal Multivariate fracture is and ankle plafond fracture, Linear associated fractures; fracture in plafond fracture Regression; -10 (- with median NISS addition to in addition to change in 20.1- - significant Bennett, P. Low score 12 for AAOS F&A hindfoot hindfoot score, CI, P- 1.0), ly lower M., 2018 Quality all groups Score Poly-trauma fracture 77 fracture value 0.030 F&A bilateral limb loss, multiple limb loss, cumulative trauma OIF/OEF disorder, service traumatic brain members w/ injury, # of Multivariate Laferrier, J. Low lower limb Wheelchair Traumatic combat injuries, Logistic Not Z., 2010 Quality loss use Poly-trauma Brain Injury 226 age, sex, race, regression, NS Significant 22

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx weight gain, pain, mental health, Quality of life, prosthetic device satisfaction and fit, health status, stroke, PTSD, TBI, pantom limb, # of surgeries, type of prosthetic. age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of surgeries, type of prosthetic, multiple-limb Vietnam loss, bilateral service limb-loss, members w/ comorbidities, Multivariate Laferrier, J. Low lower limb Wheelchair Traumatic ambulatory, Logistic Not Z., 2010 Quality loss use Poly-trauma Brain Injury 245 highly active regression, NS Significant Melcer, T., Low military- Traumatic age, log ISS, Multivariate Not 2017 Quality related DVT/PE Poly-trauma Brain Injury 625 mechanism of Logistic NS Significant 23

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx unilateral injury, injury regression, lower limb year, injury OR, CI trauma location, preinjury psychological diagnosis age, log ISS, mechanism of injury, injury military- Any year, injury related Musculoskel location, Multivariate unilateral etal preinjury Logistic Melcer, T., Low lower limb complicatio Traumatic psychological regression, Not 2017 Quality trauma ns Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Traumatic psychological regression, Not 2017 Quality trauma; Pain Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteoarthrit Traumatic psychological regression, Not 2017 Quality trauma; is Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant military- age, log ISS, related mechanism of Multivariate unilateral injury, injury Logistic Melcer, T., Low lower limb Any Traumatic year, injury regression, Not 2017 Quality trauma; infection Poly-trauma Brain Injury 625 location, OR, CI NS Significant 24

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx preinjury psychological diagnosis age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteomyelit Traumatic psychological regression, Not 2017 Quality trauma; is Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Nonhealing Traumatic psychological regression, Not 2017 Quality trauma; wounds Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteoporosi Traumatic psychological regression, Not 2017 Quality trauma; s Poly-trauma Brain Injury 625 diagnosis OR, CI NS Significant

Section 3.1. Psychological Factors Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, gender, education, poverty status, race, insurance, personality profile, medical comorbidites, preinjury work status, preinjury job type, mechanism of injury, open fracture type, severity of bone or skin damage, severity of nerve damage, reconstruction or amputation, timing of initial debridement, timing of admission, timing of definite soft Less tissue coverage, anxiety LEAP data; return to work, results in limb- SIP, walking the threatening speed, pain Multivariate increased lower- intensity, major logistic odds of O'Toole, R. High extremity Patient Psychologic 2 complication, regression, satisfactio V., 2008 Quality injures Satisfaction al Factors Anxiety 463 years less anxiety p-value p<0.1 n

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study involvement, Multivariate patients; Physical SIP self-efficacy, Logistic MacKenzie Mod. Unilateral Sub-score of Psychologic Average 84 probability of Regression; Not , E. J., 2005 Quality injuries only. >=5 points al Factors Self-efficacy 397 mon. amputation OR 1.5 Significant Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study involvement, Multivariate patients; Physical SIP self-efficacy, Logistic MacKenzie Mod. Unilateral Sub-score of Psychologic Average 84 probability of Regression; Not , E. J., 2005 Quality injuries only. >=20 points al Factors Self-efficacy 397 mon. amputation OR 1.2 Significant Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study Psychosocial involvement, Multivariate patients; SIP Sub- self-efficacy, Logistic MacKenzie Mod. Unilateral score of Psychologic Average 84 probability of Regression; Not , E. J., 2005 Quality injuries only. >=20 points al Factors Self-efficacy 397 mon. amputation OR 1.1 Significant time since Increasing pts w/ severe injury, summary Multivariate self- leg injuries Sickness score, Logistic efficacy Bosse, M. Low resulting in impact Psychologic 24 treatment, regression, -0.6, was J., 2002 Quality reconstructio Profile (SIP) al Factors Self-efficacy 460 mon. complication, percent <0.01 associated 27

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx n or education, difference, with amputation. income, race, p-value better SIP insurance, score smoking, self- efficacy, social support, lawyer hired time since injury, summary Increasing score, self- treatment, efficacy complication, was education, associated pts w/ severe Sickness income, race, Multivariate with leg injuries Impact insurance, Logistic better SIP resulting in Profile smoking, self- regression, (Psychoso reconstructio (Psychosoci efficacy, social percent cial Bosse, M. Low n or al function Psychologic 24 support, lawyer difference, -0.7, function) J., 2002 Quality amputation. score) al Factors Self-efficacy 460 mon. hired p-value <0.01 score time since injury, summary score, Increasing treatment, self- complication, efficacy education, was pts w/ severe Sickness income, race, Multivariate associated leg injuries Impact insurance, Logistic with resulting in Profile smoking, self- regression, better SIP reconstructio (Physical efficacy, social percent (Physical Bosse, M. Low n or function Psychologic 24 support, lawyer difference, -0.7, function) J., 2002 Quality amputation. score) al Factors Self-efficacy 460 mon. hired p-value <0.01 score LEAP data; age, gender, Multivariate No limb- education, logistic depressio O'Toole, R. High threatening Patient Psychologic 2 poverty status, regression, n results V., 2008 Quality lower- Satisfaction al Factors Depression 463 years race, insurance, p-value p<0.05 in an 28

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx extremity personality increased injures profile, medical odds of comorbidites, satisfactio preinjury work n status, preinjury job type, mechanism of injury, open fracture type, severity of bone or skin damage, severity of nerve damage, reconstruction or amputation, timing of initial debridement, timing of admission, timing of definite soft tissue coverage, return to work, SIP, walking speed, pain intensity, major complication, less anxiety bilateral limb loss, multiple OIF/OEF limb loss, service cumulative members w/ trauma Multivariate Laferrier, J. Low lower limb Wheelchair Psychologic disorder, Logistic Not Z., 2010 Quality loss use al Factors Depression 226 traumatic brain regression, NS Significant 29

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, prosthetic device satisfaction and fit, health status, stroke, PTSD, TBI, pantom limb, # of surgeries, type of prosthetic. age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of surgeries, type Vietnam of prosthetic, service multiple-limb members w/ loss, bilateral Multivariate Laferrier, J. Low lower limb Wheelchair Psychologic limb-loss, Logistic Not Z., 2010 Quality loss use al Factors Depression 245 comorbidities, regression, NS Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx ambulatory, highly active Compared to high, Treatment, age, low self- gender, race, efficacy is education, associated poverty status, with smoking status, increased legal odds of LEAP Study Psychosocial involvement, Multivariate high patients; SIP Sub- self-efficacy, Logistic psychosoc MacKenzie Mod. Unilateral score of Psychologic Low self- 84 probability of Regression; 2.5, ial SIP , E. J., 2005 Quality injuries only. >=20 points al Factors efficacy 397 mon. amputation OR, p-value <0.05 score Treatment, age, Compared gender, race, to high, education, low self- poverty status, efficacy is smoking status, associated legal with LEAP Study involvement, Multivariate increased patients; Physical SIP self-efficacy, Logistic odds of MacKenzie Mod. Unilateral Sub-score of Psychologic Low Self- 84 probability of Regression; 2.2, higher SIP , E. J., 2005 Quality injuries only. >=5 points al Factors efficacy 397 mon. amputation OR <0.05 score Treatment, age, Compared gender, race, to high, education, low self- poverty status, efficacy is smoking status, associated legal with LEAP Study involvement, Multivariate increased patients; Physical SIP self-efficacy, Logistic odds of MacKenzie Mod. Unilateral Sub-score of Psychologic Low Self- 84 probability of Regression; 2.2, higher SIP , E. J., 2005 Quality injuries only. >=20 points al Factors efficacy 397 mon. amputation OR <0.05 score

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury (blast or nonblast), injury year Preinjury (2001Y2005 or psychologi 2006Y2008), cal injury location diagnosis (above the knee is or below the associated knee), or Multivariate with military- Preinjury preinjury Logistic 2.62 increased Melcer, T., Low related lower Psychologic psychologic psychological regression, (1.45- odds of 2013 Quality limb injury PTSD al Factors al diagnosis 772 diagnosis. OR, CI 4.75) PTSD age, log ISS, mechanism of injury (blast or nonblast), injury Preinjury year psychologi (2001Y2005 or cal 2006Y2008), diagnosis injury location is (above the knee associated or below the with knee), or Multivariate increased military- Preinjury preinjury Logistic 4.25 odds of Melcer, T., Low related lower Substance Psychologic psychologic psychological regression, (2.21- substance 2013 Quality limb injury Abuse al Factors al diagnosis 772 diagnosis. OR, CI 8.16) abuse age, log ISS, mechanism of Early injury (blast or amputatio nonblast), injury Multivariate n is military- year Logistic 0.39 associated Melcer, T., Low related lower Early (2001Y2005 or regression, (0.24- with 2013 Quality limb injury PTSD Amputation amputation 772 2006Y2008), OR, CI 0.63) decreased 32

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury location odds of (above the knee PTSD or below the knee), or preinjury psychological diagnosis. age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or Early 2006Y2008), amputatio injury location n is (above the knee associated or below the with knee), or Multivariate decreased military- preinjury Logistic 0.54 odds of Melcer, T., Low related lower Substance Early psychological regression, (0.29- substance 2013 Quality limb injury Abuse Amputation amputation 772 diagnosis. OR, CI 0.99) abuse age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- preinjury Logistic Melcer, T., Low related lower Early psychological regression, Not 2013 Quality limb injury Anxiety Amputation amputation 772 diagnosis. OR, CI NS Significant 33

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- preinjury Logistic Melcer, T., Low related lower Adjustment Early psychological regression, Not 2013 Quality limb injury Disorders Amputation amputation 772 diagnosis. OR, CI NS Significant age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- preinjury Logistic Melcer, T., Low related lower Late psychological regression, Not 2013 Quality limb injury Anxiety Amputation amputation 772 diagnosis. OR, CI NS Significant age, log ISS, Late mechanism of amputatio injury (blast or n is nonblast), injury Multivariate associated military- year Logistic 2.16 with Melcer, T., Low related lower Mood Late (2001Y2005 or regression, (1.11- increased 2013 Quality limb injury Disorder Amputation amputation 772 2006Y2008), OR, CI 4.19) odds of 34

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury location mood (above the knee disorder or below the knee), or preinjury psychological diagnosis. age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- preinjury Logistic Melcer, T., Low related lower Adjustment Late psychological regression, Not 2013 Quality limb injury Disorders Amputation amputation 772 diagnosis. OR, CI NS Significant age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- Traumatic preinjury Logistic Melcer, T., Low related lower Brain Injury Late psychological regression, Not 2013 Quality limb injury Rate Amputation amputation 772 diagnosis. OR, CI NS Significant 35

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee or below the knee), or Multivariate military- Traumatic preinjury Logistic Melcer, T., Low related lower Brain Injury Early psychological regression, Not 2013 Quality limb injury Rate Amputation amputation 772 diagnosis. OR, CI NS Significant bilateral limb loss, multiple limb loss, cumulative trauma disorder, traumatic brain injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, prosthetic device OIF/OEF satisfaction and service fit, health members w/ status, stroke, Multivariate Laferrier, J. Low lower limb Wheelchair Psychologic PTSD, TBI, Logistic Not Z., 2010 Quality loss use al Factors PTSD 226 pantom limb, # regression, NS Significant 36

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx of surgeries, type of prosthetic. age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of surgeries, type of prosthetic, multiple-limb Vietnam loss, bilateral service limb-loss, members w/ comorbidities, Multivariate Laferrier, J. Low lower limb Wheelchair Psychologic ambulatory, Logistic Not Z., 2010 Quality loss use al Factors PTSD 245 highly active regression, NS Significant

Section 3.2. Psychosocial Support Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Age, education, employment status, marital status, other war-related mixture of injuries, history civilian and of military; hospitalization, unilateral hip prosthetic use, disarticulatio side of Multivariate Masoumi, Mod. n; avg age Psychosocial Marital disarticulation, Logistic Not M., 2014 Quality 19.54 SF-36 PCS Support Status 76 sports activities Regression NS Significant Age, education, employment status, marital status, other war-related mixture of injuries, history civilian and of military; hospitalization, unilateral hip prosthetic use, disarticulatio side of Multivariate Masoumi, Mod. n; avg age Psychosocial Marital disarticulation, Logistic Not M., 2014 Quality 19.54 SF-36 MCS Support status 76 sports activities Regression NS Significant marriage, education, age, prosthesis, Iraq-Iran war ambulation, veterans; stump washing Multivariate amputations frequency, logistic primarily due stump shape, regression, Almassi, F., Low to blast Psychosocial stump length, OR, CI, P- Not 2010 Quality injuries Skin lesion Support Marriage 335 amputation value NS Significant Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx level, excessive perspiration time since injury, summary score, treatment, complication, Increase education, in social pts w/ severe income, race, Multivariate support leg injuries insurance, Logistic results in resulting in smoking, self- regression, increased reconstructio Sickness efficacy, social percent odds of Bosse, M. Low n or impact Psychosocial Social 24 support, lawyer difference, -0.5, improved J., 2002 Quality amputation. Profile (SIP) Support support 460 mon. hired P-value P<0.10 overall SIP time since injury, summary score, Increase treatment, in social complication, support education, results in pts w/ severe Sickness income, race, Multivariate increased leg injuries Impact insurance, Logistic odds of an resulting in Profile smoking, self- regression, improved reconstructio (Physical efficacy, social percent physical Bosse, M. Low n or function Psychosocial Social 24 support, lawyer difference, -0.4, function J., 2002 Quality amputation. score) Support Support 460 mon. hired P-value P<0.05 score time since Increase injury, summary in social score, support pts w/ severe Sickness treatment, Multivariate results in leg injuries Impact complication, Logistic increased resulting in Profile education, regression, odds of an reconstructio (Psychosoci income, race, percent improved Bosse, M. Low n or al function Psychosocial Social 24 insurance, difference, -0.8, psychosoc J., 2002 Quality amputation. score) Support Support 460 mon. smoking, self- P-value P<0.01 ial 39

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx efficacy, social function support, lawyer score hired

Section 4. Rehabilitation Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx LCI is Multiple associated Regression with higher Unilateral Analysis, odds of amputation as a Psychosoci Advanced standardize improved result of al physical gender, phantom d 0.32, psychosoci Wen, P. Low earthquake Adjustmen Rehabilitati abilities pain, advanced coefficient, <0.00 al S., 2018 Quality injuries t on (LCI) 140 physical abilities p-value 1 adjustment age, gender, race, time of injury, education, injury severity score, head injury, neck Unilateral and injury, premorbid Multivariate bilateral illness, Logit amputees; Inpatient amputation level, Regression, - Pezzin, L. Mod. average ISS: SF-36 (Low Rehabilitati rehabilitati postamputation Estimate, p- 0.904, Not E., 2000 Quality 18.5 PCS) on on use 78 surgeries value 0.17 Significant age, gender, race, time of injury, education, injury severity score, head injury, neck Inpatient Unilateral and injury, premorbid Multivariate rehab use bilateral illness, Logit results in amputees; Inpatient amputation level, Regression, - decreased Pezzin, L. Mod. average ISS: SF-36 (Low Rehabilitati rehabilitati postamputation Estimate, p- 0.385, odds of E., 2000 Quality 18.5 RP) on on use 78 surgeries value 0.01 Low RP age, gender, Unilateral and Inpatient race, time of Multivariate - Pezzin, L. Mod. bilateral SF-36 (Low Rehabilitati rehabilitati injury, education, Logit 0.645, Not E., 2000 Quality amputees; BP) on on use 78 injury severity Regression, 0.06 Significant Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx average ISS: score, head Estimate, p- 18.5 injury, neck value injury, premorbid illness, amputation level, postamputation surgeries age, gender, race, time of injury, education, injury severity score, head injury, neck Unilateral and injury, premorbid Multivariate bilateral illness, Logit amputees; Inpatient amputation level, Regression, - Pezzin, L. Mod. average ISS: SF-36 (Low Rehabilitati rehabilitati postamputation Estimate, p- 0.533, Not E., 2000 Quality 18.5 VT) on on use 78 surgeries value 0.07 Significant age, gender, race, time of injury, education, injury severity score, head injury, neck Unilateral and injury, premorbid Multivariate bilateral illness, Logit amputees; Inpatient amputation level, Regression, - Pezzin, L. Mod. average ISS: SF-36 (Low Rehabilitati rehabilitati postamputation Estimate, p- 0.004, Not E., 2000 Quality 18.5 RE) on on use 78 surgeries value 0.99 Significant age, gender, Unilateral and race, time of Multivariate bilateral injury, education, Logit amputees; Return to Inpatient injury severity Regression, Pezzin, L. Mod. average ISS: Work Rehabilitati rehabilitati score, head Estimate, p- 2.796, Not E., 2000 Quality 18.5 (RTW) on on use 76 injury, neck value .09 Significant 42

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx injury, premorbid illness, amputation level, postamputation surgeries patient insurance status, educational level, preinjury fitness pts w/ level, smoking unmet PT history, self- need (as efficacy for referred by return to work, a Physical practical social Therapist) support, severity has of muscle injury, decreased site and extent of odds of Improveme bone injury, pain improveme nt in intensity, and Multivariate 0.44 nt Reciprocal PT Need impairment level Logistic (0.21- compared Castillo, Stair (Physical at the first time regression, 0.93), to pts w/ R. C., Mod. Climbing Rehabilitati Therapist 6 point of the OR, CI, p- P<0.0 met PT 2008 Quality LEAP data Pattern on Referral) 321 months selected period. value 5 needs patient insurance status, educational level, preinjury fitness level, smoking history, self- Improveme efficacy for nt in return to work, Reciprocal PT Need practical social Multivariate Castillo, Stair (Physical support, severity Logistic 0.57 R. C., Mod. Climbing Rehabilitati Therapist 12 of muscle injury, regression, (0.34- Not 2008 Quality LEAP data Pattern on Referral) 321 months site and extent of OR, CI 1.22) Significant 43

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx bone injury, pain intensity, and impairment level at the first time point of the selected period. patient insurance status, educational level, preinjury fitness pts w/ level, smoking unmet PT history, self- need (as efficacy for referred by return to work, a Physical practical social Therapist) support, severity has of muscle injury, decreased site and extent of odds of Improveme bone injury, pain improveme nt in intensity, and Multivariate 0.49 nt Reciprocal PT Need impairment level Logistic (0.20- compared Castillo, Stair (Physical at the first time regression, 0.96), to pts w/ R. C., Mod. Climbing Rehabilitati Therapist 24 point of the OR, CI, p- P<0.0 met PT 2008 Quality LEAP data Pattern on Referral) 321 months selected period. value 5 needs patient insurance status, educational level, preinjury fitness level, smoking Improveme history, self- nt in efficacy for Reciprocal PT Need return to work, Multivariate Castillo, Stair (Orthopedi practical social Logistic 0.68 R. C., Mod. Climbing Rehabilitati c Surgeon 6 support, severity regression, (0.31- Not 2008 Quality LEAP data Pattern on Referral) 321 months of muscle injury, OR, CI 1.35) Significant 44

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx site and extent of bone injury, pain intensity, and impairment level at the first time point of the selected period. patient insurance status, educational level, preinjury fitness level, smoking history, self- efficacy for return to work, practical social support, severity of muscle injury, site and extent of Improveme bone injury, pain nt in intensity, and Reciprocal PT Need impairment level Multivariate Castillo, Stair (Orthopedi at the first time Logistic 0.65 R. C., Mod. Climbing Rehabilitati c Surgeon 12 point of the regression, (0.38- Not 2008 Quality LEAP data Pattern on Referral) 321 months selected period. OR, CI 1.33) Significant patient insurance status, educational level, preinjury fitness Improveme level, smoking nt in history, self- Reciprocal PT Need efficacy for Multivariate Castillo, Stair (Orthopedi return to work, Logistic 0.88 R. C., Mod. Climbing Rehabilitati c Surgeon 24 practical social regression, (0.45- Not 2008 Quality LEAP data Pattern on Referral) 321 months support, severity OR, CI 1.70) Significant 45

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx of muscle injury, site and extent of bone injury, pain intensity, and impairment level at the first time point of the selected period. patient insurance status, educational level, preinjury fitness pts w/ level, smoking unmet PT history, self- need (as efficacy for referred by return to work, a Physical practical social Therapist) support, severity has of muscle injury, decreased site and extent of odds of bone injury, pain improveme Improveme intensity, and Multivariate 0.54 nt nt in Gait PT Need impairment level Logistic (0.34- compared Castillo, Deviations (Physical at the first time regression, 0.96), to pts w/ R. C., Mod. While Rehabilitati therapist 12 point of the OR, CI, p- P<0.0 met PT 2008 Quality LEAP data Walking on Referral) 321 months selected period. value 5 needs patient insurance pts w/ status, unmet PT educational level, need (as preinjury fitness referred by Improveme level, smoking Multivariate 0.37 a Physical nt in Gait PT Need history, self- Logistic (0.20- Therapist) Castillo, Deviations (Physical efficacy for regression, 0.86), has R. C., Mod. While Rehabilitati therapist 24 return to work, OR, CI, p- P<0.0 decreased 2008 Quality LEAP data Walking on Referral) 321 months practical social value 5 odds of 46

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx support, severity improveme of muscle injury, nt site and extent of compared bone injury, pain to pts w/ intensity, and met PT impairment level needs at the first time point of the selected period. patient insurance status, educational level, preinjury fitness level, smoking history, self- efficacy for return to work, practical social support, severity of muscle injury, site and extent of bone injury, pain Improveme intensity, and nt in Gait PT Need impairment level Multivariate Castillo, Deviations (Orthopedi at the first time Logistic 0.71 R. C., Mod. While Rehabilitati c Surgeon 12 point of the regression, (0.46- Not 2008 Quality LEAP data Walking on Referral) 321 months selected period. OR, CI 1.87) Significant patient insurance status, educational level, Improveme preinjury fitness nt in Gait PT Need level, smoking Multivariate Castillo, Deviations (Orthopedi history, self- Logistic 0.48 R. C., Mod. While Rehabilitati c Surgeon 24 efficacy for regression, (0.35- Not 2008 Quality LEAP data Walking on Referral) 321 months return to work, OR, CI 1.18) Significant 47

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx practical social support, severity of muscle injury, site and extent of bone injury, pain intensity, and impairment level at the first time point of the selected period. patient insurance status, educational level, preinjury fitness pts w/ level, smoking unmet PT history, self- need (as efficacy for referred by return to work, a Physical practical social Therapist) support, severity has of muscle injury, decreased site and extent of odds of bone injury, pain improveme Improveme intensity, and Multivariate 0.45 nt nt in PT Need impairment level Logistic (0.24- compared Castillo, Maximum (Physical at the first time regression, 0.92), to pts w/ R. C., Mod. Walking Rehabilitati therapist 6 point of the OR, CI, p- P<0.0 met PT 2008 Quality LEAP data Speed on Referral) 321 months selected period. value 5 needs patient insurance pts w/ status, unmet PT Improveme educational level, Multivariate 0.52 need (as nt in PT Need preinjury fitness Logistic (0.25- referred by Castillo, Maximum (Physical level, smoking regression, 0.97), a Physical R. C., Mod. Walking Rehabilitati therapist 12 history, self- OR, CI, p- P<0.0 Therapist) 2008 Quality LEAP data Speed on Referral) 321 months efficacy for value 5 has 48

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx return to work, decreased practical social odds of support, severity improveme of muscle injury, nt site and extent of compared bone injury, pain to pts w/ intensity, and met PT impairment level needs at the first time point of the selected period. patient insurance status, educational level, preinjury fitness pts w/ level, smoking unmet PT history, self- need (as efficacy for referred by return to work, a Physical practical social Therapist) support, severity has of muscle injury, decreased site and extent of odds of bone injury, pain improveme Improveme intensity, and Multivariate 0.39 nt nt in PT Need impairment level Logistic (0.15- compared Castillo, Maximum (Physical at the first time regression, 0.85), to pts w/ R. C., Mod. Walking Rehabilitati therapist 24 point of the OR, CI, p- P<0.0 met PT 2008 Quality LEAP data Speed on Referral) 321 months selected period. value 1 needs patient insurance Improveme status, nt in PT Need educational level, Multivariate Castillo, Maximum (Orthopedi preinjury fitness Logistic 0.69 R. C., Mod. Walking Rehabilitati c Surgeon 6 level, smoking regression, (0.29- Not 2008 Quality LEAP data Speed on Referral) 321 months history, self- OR, CI 1.38) Significant 49

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx efficacy for return to work, practical social support, severity of muscle injury, site and extent of bone injury, pain intensity, and impairment level at the first time point of the selected period. patient insurance status, educational level, preinjury fitness level, smoking history, self- efficacy for return to work, practical social support, severity of muscle injury, site and extent of bone injury, pain Improveme intensity, and nt in PT Need impairment level Multivariate Castillo, Maximum (Orthopedi at the first time Logistic 0.94 R. C., Mod. Walking Rehabilitati c Surgeon 12 point of the regression, (0.57- Not 2008 Quality LEAP data Speed on Referral) 321 months selected period. OR, CI 1.79) Significant patient insurance PT Need status, educational Multivariate Castillo, Improveme (Orthopedi level, preinjury Logistic 0.90 R. C., Mod. nt in Rehabilitati c Surgeon 24 fitness level, regression, (0.44- Not 2008 Quality LEAP data Maximum on Referral) 321 months smoking history, OR, CI 2.04) Significant

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx Walking self-efficacy for Speed return to work, practical social support, severity of muscle injury, site and extent of bone injury, pain intensity, and impairment level at the first time point of the selected period. Return to run and IDEO Return to results in Run and 7.96 increased Intrepid Multivariate (2.20- odds of service Dynamic Logistic 28.83) RTD members w/ Exoskeletal regression, , compared Blair, J. Low below the knee Return to Return to Orthosis age, military OR, CI, p- 0.000 to IDEO A., 2014 Quality injury Duty Run (IDEO) 235 rank, rtr value 1 only

Section 5. Health Scores PICO 1 Ref. title Quality Patient Outcome RF Type Full RF N Confounding Statistic Result Author Characteristics Title name Adjustment Reported Favored Tx ISS, glasgow Multivariate Pts with Glasgow Glasgow coma scale, age, 13.0 (2.4- Asensio, J. Low pts w/ femoral Health Logistic coma scale <8 Mortality Coma Scale 204 coagulopathy, 83.6), A., 2006 Quality vessel injury Score Regression; have higher odds <8 >=2 known hard 0.004 OR, CI, P-value of mortality vascular signs ISS, glasgow Multivariate coma scale, age, 22.4 (5.2- Pts with a ISS >25 Asensio, J. Low pts w/ femoral Health Logistic Mortality ISS >25 204 coagulopathy, 125.7), have higher odds A., 2006 Quality vessel injury Scores Regression; >=2 known hard <0.0001 of mortality OR, CI, P-value vascular signs

PICO2 Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx P-amp score, treatment, age, gender, race, education, smoking status, invovment w/ LEAP Data; legal system, Unilateral self efficacy, job injuries; tenure, job 3 Month motor involvement, 3- physical vehicle month VAS pain, Proportional SIP score primary 3 Month 3-month Hazards 0.97 decreases MacKenzie High mechanism Return to Health physical SIP 84 physical SIP regression, (0.96- risk of , E. J., 2006 Quality of injury Work (RTW) Scores score 423 mon. score RR, CI 0.98) RTW level of amputation, age, education, insurance, All pts income, unilateral smoking status, lower limb chronic medical Multivariate amputation, conditions, Logistic most injuries injury severity regression, from motor Physical Injury score, ipsilateral percent MacKenzie Mod. vehicle Function of Health Severity injury, self- difference, 16.9, Not , E. J., 2004 Quality accident SIP Scores Score 124 efficacy p-value 0.16 Significant All pts level of unilateral amputation, lower limb age, education, Multivariate amputation, insurance, Logistic most injuries income, regression, from motor Psychosocial Injury smoking status, percent MacKenzie Mod. vehicle Function of Health Severity chronic medical difference, 29.7, Not , E. J., 2004 Quality accident SIP Scores Score 124 conditions, p-value 0.12 Significant 53

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury severity score, ipsilateral injury, self- efficacy level of amputation, age, education, insurance, All pts income, unilateral smoking status, lower limb chronic medical amputation, conditions, most injuries injury severity Multivariate from motor Walking Injury score, ipsilateral Logistic MacKenzie Mod. vehicle speed (>=4 Health Severity injury, self- regression, Not , E. J., 2004 Quality accident ft/sec) Scores Score 124 efficacy OR, p-value 0.39, 12 Significant level of amputation, age, education, insurance, All pts income, unilateral smoking status, lower limb chronic medical Multivariate amputation, conditions, Logistic most injuries Overall injury severity regression, from motor Sickness Injury score, ipsilateral percent MacKenzie Mod. vehicle impact Health Severity injury, self- difference, 19.5, Not , E. J., 2004 Quality accident Profile (SIP) Scores Score 124 efficacy p-value 0.13 Significant ISS, age, time to Increase initial in ISS procedure, Multivariate results in pts w/ any Post- neurovascular Logistic 1.058 increased lower surgical Injury injury, regression, (1.05- odds of Low, E. E., Low extremity Complicatio Health Severity compartment OR, CI, p- 1.066), post- 2017 Quality amputation ns Scores Score (ISS) 2314 syndrome, value <0.0001 surgical 54

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx hospital complicati teaching status, ons race ISS, age, crush fracture, compartment syndrome, major post- ISS results surgical Multivariate in pts w/ any complication, Logistic 1.015 increased lower Injury fracture type, regression, (1.008- odds of Low, E. E., Low extremity Amputation Health Severity hospital OR, CI, p- 1.022), amputatio 2017 Quality amputation Revision Scores Score (ISS) 2314 teaching status value <0.0001 n revision ISS, time to ISS is a procedure, age, Multivariate significant compartment Logistic predictor pts w/ any syndrome, regression, 0.4796 of length lower Length of Injury hospital parameter (0.4255- of Low, E. E., Low extremity Hospitalizati Health Severity teaching status, estimate, CI, 0.5338), hospitaliz 2017 Quality amputation on Scores Score (ISS) 2314 race, gender p-value <0.0001 ation age, log ISS, mechanism of injury, injury military- year, injury ISS results related location, Multivariate in unilateral preinjury Logistic increased Melcer, T., Low lower limb Health psychological regression, 1.43(1.1 odds of 2017 Quality trauma DVT/PE Scores ISS (log) 625 diagnosis OR, CI 5-1.77) DVT/PE age, log ISS, ISS results military- Any mechanism of in related Musculoskel injury, injury Multivariate increased unilateral etal year, injury Logistic 1.23 odds of Melcer, T., Low lower limb complicatio Health location, regression, (1.05- musculosk 2017 Quality trauma ns Scores ISS (log) 625 preinjury OR, CI 1.44) eletal

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx psychological complicati diagnosis ons age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Health psychological regression, Not 2017 Quality trauma; Pain Scores ISS (log) 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteoarthrit Health psychological regression, Not 2017 Quality trauma; is Scores ISS (log) 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate Low unilateral preinjury Logistic Melcer, T., Quality lower limb Osteoporosi Health psychological regression, Not 2017 y trauma; s Scores ISS (log) 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury ISS results military- year, injury in related location, Multivariate increased unilateral preinjury Logistic 1.34 odds of Melcer, T., Low lower limb Any Health psychological regression, (1.16- any 2017 Quality trauma; infection Scores ISS (log) 625 diagnosis OR, CI 1.54) infection

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury, injury ISS results military- year, injury in related location, Multivariate increased unilateral preinjury Logistic 1.43 odds of Melcer, T., Low lower limb Osteomyelit Health psychological regression, (1.15- osteomyel 2017 Quality trauma; is Scores ISS (log) 625 diagnosis OR, CI 1.77) itis age, log ISS, mechanism of injury, injury ISS results military- year, injury in related location, Multivariate increased unilateral preinjury Logistic 1.50 odds of Melcer, T., Low lower limb Nonhealing Health psychological regression, (1.22- nonhealin 2017 Quality trauma; wounds Scores ISS (log) 625 diagnosis OR, CI 1.85) g wounds age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee ISS is or below the associated knee), or Multivariate with military- preinjury Logistic 1.60 increased Melcer, T., Low related lower Health psychological regression, (1.16- odds of 2013 Quality limb injury Anemia Scores ISS (log) 772 diagnosis. OR, CI 2.20) anemia age, log ISS, ISS is mechanism of Multivariate associated military- injury (blast or Logistic 2.17 with Melcer, T., Low related lower Any Health nonblast), injury regression, (1.54- increased 2013 Quality limb injury Infection Scores ISS (log) 772 year OR, CI 3.06) odds of 57

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx (2001Y2005 or any 2006Y2008), infection injury location (above the knee or below the knee), or preinjury psychological diagnosis. age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or 2006Y2008), injury location (above the knee ISS is or below the associated knee), or Multivariate with military- preinjury Logistic 1.86 increased Melcer, T., Low related lower Health psychological regression, (1.26- odds of 2013 Quality limb injury Cellulitis Scores ISS (log) 772 diagnosis. OR, CI 2.73) cellulitis age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or ISS is 2006Y2008), associated injury location with (above the knee Multivariate increased military- or below the Logistic 1.52 odds of Melcer, T., Low related lower Osteomyelit Health knee), or regression, (1.05- osteomyel 2013 Quality limb injury is Scores ISS (log) 772 preinjury OR, CI 2.19) itis 58

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx psychological diagnosis. age, log ISS, mechanism of injury (blast or nonblast), injury year (2001Y2005 or ISS is 2006Y2008), associated injury location with (above the knee increased or below the odds of knee), or Multivariate heterotop military- preinjury Logistic 2.32 ic Melcer, T., Low related lower Heterotopic Health psychological regression, (1.26- ossificatio 2013 Quality limb injury Ossification Scores ISS (log) 772 diagnosis. OR, CI 4.28) n servicememb ers with Comprehen NISS in pts traumatic sive High- Stepwise w/ TFA is lower limb Level waist regression associated loss Activity circumference, analysis, with (Unilateral Mobility prosthetic, NISS, parameter lower Gaunaurd, Low transfemoral Predictor Health sit down estimate, p- -0.16, CHAMP I. A., 2013 Quality amputation) (CHAMP) Scores NISS 32 (AMPPro 13) value 0.03 score age, gender, race, time of injury, education, Overall injury severity Injury score, head Severity Unilateral injury, neck Multivariate Score and bilateral Overall injury, Logit results in amputees; Injury premorbid Regression, increased Pezzin, L. Mod. average ISS: SF-36 (Low Health Severity illness, Estimate, p- 0.462, odds of E., 2000 Quality 18.5 PCS) Scores Score 78 amputation value 0.02 Low PCS 59

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx level, postamputation surgeries age, gender, race, time of injury, education, injury severity score, head injury, neck Overall injury, Injury premorbid Severity Unilateral illness, Multivariate Score and bilateral Overall amputation Logit results in amputees; Injury level, Regression, increased Pezzin, L. Mod. average ISS: SF-36 (Low Health Severity postamputation Estimate, p- 0.227, odds of E., 2000 Quality 18.5 RP) Scores Score 78 surgeries value 0.01 Low RP age, gender, race, time of injury, education, injury severity score, head injury, neck injury, premorbid Unilateral illness, Multivariate and bilateral Overall amputation Logit amputees; Injury level, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Health Severity postamputation Estimate, p- 0.047, Not E., 2000 Quality 18.5 BP) Scores Score 78 surgeries value 0.38 Significant Overall age, gender, Overall Unilateral Injury race, time of Multivariate Injury Pezzin, L. Mod. and bilateral SF-36 (Low Health Severity injury, Logit 0.090, Severity E., 2000 Quality amputees; VT) Scores Score 78 education, Regression, 0.05 Score 60

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx average ISS: injury severity Estimate, p- results in 18.5 score, head value increased injury, neck odds of injury, Low VT premorbid illness, amputation level, postamputation surgeries age, gender, race, time of injury, education, injury severity score, head injury, neck injury, premorbid Unilateral illness, Multivariate and bilateral Overall amputation Logit amputees; Injury level, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Health Severity postamputation Estimate, p- -0.023, Not E., 2000 Quality 18.5 RE) Scores Score 78 surgeries value 0.66 Significant age, gender, race, time of injury, education, injury severity score, head Unilateral injury, neck Multivariate and bilateral Overall injury, Logit amputees; Injury premorbid Regression, Pezzin, L. Mod. average ISS: Return to Health Severity illness, Estimate, p- 0.050, Not E., 2000 Quality 18.5 Work (RTW) Scores Score 76 amputation value 0.25 Significant 61

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx level, postamputation surgeries Sickness Limb Multiple Ly, T. V., Mod. impact Health Salvage 6 Linear Not 2008 Quality LEAP data Profile (SIP) Scores Index (LSI) 407 mon. age Regression NS Significant Sickness Limb Multiple Ly, T. V., Mod. impact Health Salvage 24 Linear Not 2008 Quality LEAP data Profile (SIP) Scores Index (LSI) 407 mon. age Regression NS Significant Mangled extremity Sickness severity Multiple Ly, T. V., Mod. impact Health score 6 Linear Not 2008 Quality LEAP data Profile (SIP) Scores (MESS) 407 mon. age Regression NS Significant Mangled extremity Sickness severity Multiple Ly, T. V., Mod. impact Health score 24 Linear Not 2008 Quality LEAP data Profile (SIP) Scores (MESS) 407 mon. age Regression NS Significant Sickness Predictive Multiple Ly, T. V., Mod. impact Health Salvage 6 Linear Not 2008 Quality LEAP data Profile (SIP) Scores Index (PSI) 407 mon. age Regression NS Significant Sickness Predictive Multiple Ly, T. V., Mod. impact Health Salvage 24 Linear Not 2008 Quality LEAP data Profile (SIP) Scores Index (PSI) 407 mon. age Regression NS Significant

Section 6. Insensate/Nerve Injury Regression Insensate/Nerve Injury Data Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Negative Bohler's angle, coexisting talal and calcaneal fracture, coexisting plafond Military foot fracture, and ankle coexisting mid- fractures; foot fracture, median NISS open fracture, Multivariate Bennett, P. Low score 12 for AAOS F&A Insensate/N nerve injury, Linear Not M., 2018 Quality all groups Score erve Injuries Nerve injury 77 vascular injury Regression NS Significant ISS, age, time to initial Neurovasc procedure, ular Injury neurovascular results in injury, increased compartment Multivariate odds of pts w/ any Post- syndrome, Logistic 1.353 post- lower surgical hospital regression, (1.088- surgical Low, E. E., Low extremity Complicatio Vascular Neurovascul teaching status, OR, CI, p- 1.683), complicati 2017 Quality amputation ns Injury ar Injury 2314 race value 0.0065 ons

Continuous Insensate/Nerve Injury Data Reference Quality Outcome Follow- N(1) N(2) Treatment Treatment Statistic Mean Mean Result Significance Details up Time Details(1) Details(2) (SD) 1 (SD) 2 Mean AMA Sensate Insensate Bosse, M. Mod. Range of 12 Control Mean 0.34 0.3 24 25 Salvage 0.04 (-0.1-0.18) J., 2005 Quality Motion months Group Dif (0.21) (0.27) Not Group Score (Salvage) Significant Mean AMA Sensate Insensate Bosse, M. Mod. Range of 24 Control Mean 0.27 0.28 19 22 Salvage -0.01 (-0.18-0.16) J., 2005 Quality Motion months Group Dif (0.25) (0.29) Not Group Score (Salvage) Significant Sensate Insensate Bosse, M. Mod. Mean Visual 12 Control Mean 24.5 25.9 -1.4 (-13.75- 24 25 Salvage J., 2005 Quality Pain Score months Group Dif (22.1) (22) 10.95) Not Group (Salvage) Significant Sensate Insensate Bosse, M. Mod. Mean Visual 24 Control Mean 30.5 31.7 19 22 Salvage -1.2 (-17.3-14.9) J., 2005 Quality Pain Score months Group Dif (28.6) (23.2) Not Group (Salvage) Significant Sensate Insensate Bosse, M. Mod. SIP - 12 Control Mean 9.7 10.2 24 25 Salvage -0.5 (-5.62-4.62) J., 2005 Quality Physical months Group Dif (8.9) (9.4) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. SIP - 24 Control Mean 8.8 19 22 Salvage 8.6 (7.8) 0.2 (-5.17-5.57) J., 2005 Quality Physical minutes Group Dif (9.5) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. SIP - 12 Control Mean 10.7 24 25 Salvage 8.5 (9.6) 2.2 (-4.92-9.32) J., 2005 Quality Psychosocial months Group Dif (15.1) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. SIP - 24 Control Mean 10.9 19 22 Salvage 5.8 (9.6) 5.1 (-2.98-13.18) J., 2005 Quality Psychosocial months Group Dif (15.6) Not Group (Salvaged) Significant

Reference Quality Outcome Follow- N(1) N(2) Treatment Treatment Statistic Mean Mean Result Significance Details up Time Details(1) Details(2) (SD) 1 (SD) 2 Sensate Insensate Bosse, M. Mod. 12 Control Mean 34.8 44.2 SIP - Work 24 25 Salvage -9.4 (-27.26-8.46) J., 2005 Quality months Group Dif (32.7) (31) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. 24 Control Mean 38.1 41.6 -3.5 (-23.44- SIP - Work 19 22 Salvage J., 2005 Quality months Group Dif (31.4) (33.7) 16.44) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. SIP Score - 12 Control Mean 12.3 24 25 Salvage 11.9 (9) 0.4 (-5.49-6.29) J., 2005 Quality Overall months Group Dif (11.8) Not Group (Salvaged) Significant Sensate Insensate Bosse, M. Mod. SIP Score - 24 Control Mean 11.6 19 22 Salvage 9.6 (7.6) 2 (-4.03-8.03) J., 2005 Quality Overall months Group Dif (11.4) Not Group (Salvaged) Significant

Dichotomous Insensate/Nerve Injury Data Reference Quality Treatment Treatment Outcome Follow- N(1) N(2) Statistic Percent Percent Result Significance (1) (2) up Events Events Time (1) (2) Sensate Insensate 3.29 Bosse, M. Mod. Control Patients full 12 Odds Salvage 24 25 0.875 0.68 (0.76- J., 2005 Quality Group weight-bearing months Ratio Not Group 14.37) (Salvage) Significant Percentage of Sensate Insensate pts returning to 0.87 Bosse, M. Mod. Control 12 Odds Salvage work (among 19 23 0.316 0.348 (0.24- J., 2005 Quality Group months Ratio Group those working 3.15) Not (Salvaged) before injury) Significant Compared to amputation Sensate Pts able to Insensate 1.77 there were Bosse, M. Mod. Control climb and 12 Odds Salvage 24 25 0.542 0.4 (0.57- more pts J., 2005 Quality Group descend stairs months Ratio Group 5.51) climbing (Salvaged) reciprocally stairs in the ins. salvage group Ins. Salvage group had significantly Sensate less pts Insensate Patients with 0.27 Bosse, M. Mod. Control 12 Odds using Salvage immobilization 24 25 0.292 0.6 (0.08- J., 2005 Quality Group months Ratio immobilizati Group device 0.9) (Salvage) on devices compared to amputation Compared Sensate Insensate to Bosse, M. Mod. Control Patients using 12 Odds 0.9 (0.28- Salvage 24 25 0.375 0.4 amputation J., 2005 Quality Group walking aid months Ratio 2.84) Group there were (Salvaged) less pts

Reference Quality Treatment Treatment Outcome Follow- N(1) N(2) Statistic Percent Percent Result Significance (1) (2) up Events Events Time (1) (2) using walking aids in ins. salvage group Sensate Pts able to Insensate 0.52 Bosse, M. Mod. Control climb and 24 Odds Salvage 19 22 0.579 0.727 (0.14- J., 2005 Quality Group descend stairs months Ratio Not Group 1.91) (Salvaged) reciprocally Significant Ins. Salvage group had significantly Sensate less pts Insensate Patients with 0.32 Bosse, M. Mod. Control 24 Odds using Salvage immobilization 19 22 0.211 0.455 (0.08- J., 2005 Quality Group months Ratio immobilizati Group device 1.28) (Salvage) on devices compared to amputation Sensate Insensate Bosse, M. Mod. Control Patients using 24 Odds 0.5 (0.11- Salvage 19 22 0.158 0.273 J., 2005 Quality Group walking aid months Ratio 2.35) Not Group (Salvaged) Significant Sensate Insensate 0.09 (- Bosse, M. Mod. Control Patients full 24 Risk Salvage 19 22 1 0.91 0.03- J., 2005 Quality Group weight-bearing months Difference Not Group 0.21) (Salvage) Significant Percentage of Sensate Insensate pts returning to 1.14 Bosse, M. Mod. Control 24 Odds Salvage work (among 18 21 0.56 0.524 (0.32- J., 2005 Quality Group months Ratio Group those working 4.02) Not (Salvaged) before injury) Significant

Reference Quality Treatment Treatment Outcome Follow- N(1) N(2) Statistic Percent Percent Result Significance (1) (2) up Events Events Time (1) (2) Sensate Insensate Foot sensation 0.75 Bosse, M. Mod. Control 24 Odds Salvage at 24 months - 19 20 0.17 0.2 (0.14- J., 2005 Quality Group months Ratio Not Group Amputated 3.9) (Salvage) Significant Sensate Insensate Foot sensation 1.13 Bosse, M. Mod. Control 24 Odds Salvage at 24 months - 19 20 0.57 0.55 (0.32- J., 2005 Quality Group months Ratio Not Group Normal 3.99) (Salvage) Significant Sensate Insensate Foot sensation Bosse, M. Mod. Control 24 Odds 0.8 (0.18- Salvage at 24 months - 19 20 0.22 0.25 J., 2005 Quality Group months Ratio 3.57) Not Group Impaired (Salvage) Significant Sensate Insensate Foot sensation 0.05 (- Bosse, M. Mod. Control 24 Risk Salvage at 24 months - 19 20 0.06 0 0.05- J., 2005 Quality Group months Difference Not Group Absent 0.15) (Salvage) Significant

Section 7. Crushed/Blunt Injury Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Military- related OEF, blunt amputees; injury, multiple avg age 23, amputations, Multivariate Blunt IED most transfemoral Logistic 2.33 injury common Pulmonary amputation, ISS, regression, (0.78- results in Hutchison, Low mechanism embolism Crushed abdomen AIS, OR, CI, p- 4.17), increased T. N., 2014 Quality of injury (PE) Injury Blunt injury 1003 extremity AIS value 0.0052 odds of PE Amputee who had popliteal artery age, blunt trauma; avg injury, vein age = 32; injury, mess, Logistic Melton, S. Low mean ISS = Secondary Crushed heparin/urokina Regresison; 4.03, Not M., 1997 Quality 10. Amputation Injury Blunt injury 14 se OR, P-value 0.06 Significant ISS, age, crush fracture, compartment sysndrome, Crush major post- fracture surgical Multivariate results in pts w/ any complication, Logistic 1.365 increased lower fracture type, regression, (1.077- odds of Low, E. E., Low extremity Amputation Crushed Crush hospital OR, CI, p- 1.73), amputatio 2017 Quality amputation Revision Injury Fracture 2314 teaching status value 0.0101 n revision

Section 8. Physiologic Viability PICO 1 Ref. title Quality Patient Outcome RF Type Full RF N Confounding Statistic Result Author Characteristics Title name Adjustment Reported Favored Tx ISS, glasgow Multivariate Pts with coma scale, age, 8.3 (1.8- Asensio, J. Low pts w/ femoral Physiologic Coagulopat Logistic coagulopathy Mortality 204 coagulopathy, 42.3), A., 2006 Quality vessel injury Viability hy in OR Regression; have higher odds >=2 known hard 0.007 OR, CI, P-value of mortality vascular signs ISS, glasgow Multivariate Pts with >=2 hard No of hard coma scale, age, 8.1 (1.5- Asensio, J. Low pts w/ femoral Physiologic Logistic vascular signs Mortality vascular 204 coagulopathy, 68.2), A., 2006 Quality vessel injury Viability Regression; have higher odds signs >=2 >=2 known hard 0.029 OR, CI, P-value of mortality vascular signs

PICO 2 Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Military group; open components of fractures; the MESS score Group (skeletal/soft Limb analyzed in tissue injury, ischemia regression limb ischemia, was were those shock, age), G–A Multivariate predictive with classification, Logistic of failure Doucet, J. Low attempted Failure of Physiologic Limb mechanism, and Regression, of limb J., 2011 Quality salvage limb salvage Viability ischemia 82 transfusions P-value p<0.001 salvage Military group; open components of fractures; Shock the MESS score Group (described (skeletal/soft analyzed in in text as tissue injury, regression components limb ischemia, were those of the MESS shock, age), G–A with score, other classification, Multivariate Doucet, J. Low attempted Failure of Physiologic than mechanism, and Logistic Not J., 2011 Quality salvage limb salvage Viability ischemia) 82 transfusions Regression NS Significant

Section 9. Comorbidities Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx descend stairs (AMPPro 20b), Waist ascend stairs circumfer servicememb (AMPPro 20a), ence in ers with Comprehen waist pts w/ traumatic sive High- circumference, Stepwise TTA is lower limb Level Central prosthetic, regression associated loss Activity Adiposity ankle/foot analysis, with (Unilateral Mobility (Waist assembly, time parameter lower Gaunaurd, Low transtibial Predictor Comorbiditi Circumferen since estimate, p- -0.34, CHAMP I. A., 2013 Quality amputation) (CHAMP) es ce) 60 amputation value 0.01 score Waist circumfer servicememb ence in ers with Comprehen pts w/ TFA traumatic sive High- Stepwise is lower limb Level Central waist regression associated loss Activity Adiposity circumference, analysis, with (Unilateral Mobility (Waist prosthetic, NISS, parameter lower Gaunaurd, Low transfemoral Predictor Comorbiditi Circumferen sit down estimate, p- -0.46, CHAMP I. A., 2013 Quality amputation) (CHAMP) es ce) 32 (AMPPro 13) value 0.03 score Waist circumfer Number of ence in servicememb Comprehen intact knee pts w/ ers with sive High- joint, descend Stepwise BLLA is traumatic Level Central stairs (AMPPro regression associated lower limb Activity Adiposity 20b), Standing analysis, with loss (Bilateral Mobility (Waist reach (AMPPro parameter higher Gaunaurd, Low lower limb Predictor Comorbiditi Circumferen 9), waist estimate, p- 0.31, CHAMP I. A., 2013 Quality loss) (CHAMP) es ce) 32 circumference value 0.004 score

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx >1 debridement, amputation>5 days post injury, ischaemic vascular injury/multi- planar degloving, above-knee Multivariate pts w/ non- amputation, Logistic salvageable Infection in tertiary referral, Regression, Jain, A., Low lower limb Residual Comorbiditi smoker, OR, CI, p- 0.4 (0.1- Not 2013 Quality injuries Limb es Diabetes 40 diabetes value 2.5) Significant age, gender, education, poverty status, race, insurance, personality profile, medical comorbidites, preinjury work status, preinjury job type, mechanism of injury, open fracture type, severity of bone or skin damage, severity of LEAP data; nerve damage, limb- reconstruction threatening Medical or amputation, Multivariate lower- comorbiditi timing of initial logistic O'Toole, R. High extremity Patient Comorbiditi es (does not 2 debridement, regression, Not V., 2008 Quality injures Satisfaction es specify) 463 years timing of p-value p>0.2 Significant 73

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx admission, timing of definite soft tissue coverage, return to work, SIP, walking speed, pain intensity, major complication, less anxiety age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of Number surgeries, type of of prosthetic, comorbidi multiple-limb tes results Vietnam loss, bilateral Multivariate in service limb-loss, Logistic 1.29 increased members w/ Number of comorbidities, regression, (1.15- odds of Laferrier, J. Low lower limb Wheelchair Comorbiditi comorbiditi ambulatory, OR, CI, p- 1.46), wheelchai Z., 2010 Quality loss use es es 245 highly active value <0.001 r use age, gender, Unilateral race, time of Multivariate and bilateral injury, Logit amputees; education, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Comorbiditi Premorbid injury severity Estimate, p- 3.059, Not E., 2000 Quality 18.5 PCS) es Illness 78 score, head value 0.20 Significant 74

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx injury, neck injury, premorbid illness, amputation level, postamputation surgeries age, gender, race, time of injury, education, injury severity score, head injury, neck injury, premorbid Unilateral illness, Multivariate and bilateral amputation Logit amputees; level, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Comorbiditi Premorbid postamputation Estimate, p- 2.671, Not E., 2000 Quality 18.5 RP) es Illness 78 surgeries value 0.06 Significant age, gender, race, time of injury, education, injury severity score, head injury, neck Unilateral injury, Multivariate and bilateral premorbid Logit amputees; illness, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Comorbiditi Premorbid amputation Estimate, p- 0.417, Not E., 2000 Quality 18.5 BP) es illness 78 level, value 0.67 Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx postamputation surgeries age, gender, race, time of injury, education, injury severity score, head injury, neck injury, premorbid Unilateral illness, Multivariate and bilateral amputation Logit amputees; level, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Comorbiditi Premorbid postamputation Estimate, p- 0.523, Not E., 2000 Quality 18.5 VT) es Illness 78 surgeries value 0.56 Significant age, gender, race, time of injury, education, injury severity score, head injury, neck injury, premorbid Unilateral illness, Multivariate and bilateral amputation Logit amputees; level, Regression, Pezzin, L. Mod. average ISS: SF-36 (Low Comorbiditi Premorbid postamputation Estimate, p- -1.748, Not E., 2000 Quality 18.5 RE) es Illness 78 surgeries value 0.14 Significant Unilateral age, gender, Multivariate and bilateral race, time of Logit amputees; injury, Regression, Pezzin, L. Mod. average ISS: Return To Comorbiditi Premorbid education, Estimate, p- -1.136, Not E., 2000 Quality 18.5 Work (RTW) es Illness 76 injury severity value 0.28 Significant 76

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx score, head injury, neck injury, premorbid illness, amputation level, postamputation surgeries

Section 10. Vascular Injury Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx >1 debridement, amputation>5 days post injury, ischaemic vascular injury/multi- planar degloving, above-knee pts w/ non- amputation, salvageable Infection in Ischaemic tertiary referral, Multivariate Jain, A., Low lower limb Residual Vascular Vascular smoker, Logistic Not 2013 Quality injuries Limb Injury Injury 40 diabetes Regression NS Significant Decrease age, sex, timing in no. of of flap, Patent presence/absen Arteries is ce of skin associated Decrease in paddle, with pts w/ lower no. of presence/absen Multivariate higher risk limb Patent ce bone gap, Logistic of Stranix, J. Low reconstructio Complicatio Vascular Arteries in flap type, and regression, 1.33, complicati T., 2017 Quality n ns Injury lower leg 361 number of veins RR, p-value 0.03 ons age, sex, timing Decrease of flap, in no. of presence/absen Patent ce of skin Arteries is Decrease in paddle, associated pts w/ lower no. of presence/absen Multivariate with limb Patent ce bone gap, Logistic higher risk Stranix, J. Low reconstructio Vascular Arteries in flap type, and regression, 1.63, of take- T., 2017 Quality n Take-backs Injury lower leg 361 number of veins RR, p-value 0.007 backs Stranix, J. Low pts w/ lower Total Flap Vascular Decrease in age, sex, timing Multivariate 1.54, Decrease T., 2017 Quality limb Failures Injury no. of 361 of flap, Logistic 0.02 in no. of Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx reconstructio Patent presence/absen regression, Patent n Arteries in ce of skin RR, p-value Arteries is lower leg paddle, associated presence/absen with ce bone gap, higher risk flap type, and of an number of veins increase total flap failures Negative Bohler's angle, coexisting talal and calcaneal fracture, coexisting plafond Military foot fracture, and ankle coexisting mid- fractures; foot fracture, median NISS open fracture, Multivariate Bennett, P. Low score 12 for AAOS F&A Vascular Vascular nerve injury, Linear Not M., 2018 Quality all groups Score Injury injury 77 vascular injury Regression NS Significant Amputee who had popliteal artery age, blunt trauma; avg injury, vein age = 32; injury, mess, Logistic Melton, S. Low mean ISS = Secondary Vascular heparin/urokina Regresison; 3.82, Not M., 1997 Quality 10. Amputation Injury Vein injury 14 se OR, P-value 0.06 Significant

Section 11. Injury Type Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury, injury military- Any year, injury related Musculoskel location, Multivariate unilateral etal preinjury Logistic Melcer, T., Low lower limb complicatio psychological regression, Not 2017 Quality trauma ns Other Blast Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury Blast military- year, injury injury related location, Multivariate results in unilateral preinjury Logistic 1.88 increased Melcer, T., Low lower limb psychological regression, (1.17- odds of 2017 Quality trauma; Pain Other Blast injury 625 diagnosis OR, CI 3.03) pain age, log ISS, mechanism of Blast injury, injury injury military- year, injury results in related location, Multivariate increased unilateral preinjury Logistic 2.81 odds of Melcer, T., Low lower limb Osteoarthrit psychological regression, (1.08- osteoarthr 2017 Quality trauma; is Other Blast Injury 625 diagnosis OR, CI 7.32) itis age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteoporosi psychological regression, Not 2017 Quality trauma; s Other Blast injury 625 diagnosis OR, CI NS Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Any psychological regression, Not 2017 Quality trauma; infection Other Blast injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Osteomyelit psychological regression, Not 2017 Quality trauma; is Other Blast Injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb Nonhealing psychological regression, Not 2017 Quality trauma; wounds Other Blast injury 625 diagnosis OR, CI NS Significant age, log ISS, mechanism of injury, injury military- year, injury related location, Multivariate unilateral preinjury Logistic Melcer, T., Low lower limb psychological regression, Not 2017 Quality trauma DVT/PE Other Blast injury 625 diagnosis OR, CI NS Significant pts w/ Binary Aydemir, Low traumatic Ultrasound age, disease Logistic 2.34 Not K., 2017 Quality etiology abnormality Other Mine injury 147 duration, Regression, (0.72- Significant 81

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx etiology, level of OR, CI, p- 7.59), amputation, value 0.157 OEF, blunt Military- injury, multiple related amputations, amputees; transfemoral Penetratin avg age 23, amputation, ISS, Multivariate g injury IED most abdomen AIS, Logistic 3.23 results in common Venous extremity AIS, regression, (1.89- increased Hutchison, Low mechanism thromboem Penetrating head and neck OR, CI, p- 5.56), odds of T. N., 2014 Quality of injury bolism (VTE) Other injury 1003 AIS value <0.0001 VTE

Section 12. Amputation/Salvage Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Multivariate Severe open Overall Regression; ankle and Sickness adjusted for Regression Ellington, Low hindfoot Impact 1 probability of coefficient, -1.6, Not J. K., 2013 Quality injuries Profile (SIP) Salvation Salvage 145 years amputation P-value 0.6276 Significant Multivariate Severe open Overall Regression; ankle and Sickness adjusted for Regression Ellington, Low hindfoot Impact 2 probability of coefficient, -3.1, Not J. K., 2013 Quality injuries Profile (SIP) Salvation Salvage 131 years amputation P-value 0.3353 Significant Multivariate Severe open Regression; ankle and adjusted for Regression Ellington, Low hindfoot 1 probability of coefficient, -1.2, Not J. K., 2013 Quality injuries Physical SIP Salvation Salvage 145 years amputation P-value 0.6968 Significant Multivariate Severe open Regression; ankle and adjusted for Regression Ellington, Low hindfoot 2 probability of coefficient, -0.8, Not J. K., 2013 Quality injuries Physical SIP Salvation Salvage 131 years amputation P-value 0.7838 Significant Multivariate Severe open Regression; ankle and adjusted for Regression Ellington, Low hindfoot Psychosocial 2 probability of coefficient, -5.3, Not J. K., 2013 Quality injuries SIP Salvation Salvage 131 years amputation P-value 0.1964 Significant Multivariate Severe open Regression; ankle and Re- adjusted for Regression Ellington, Low hindfoot hospitalizati 2 probability of coefficient, 0.3, Not J. K., 2013 Quality injuries on Salvation Salvage 131 years amputation P-value 0.0911 Significant Time to full adjusted for Multivariate Salvage Ellington, Low Severe open weight 2 probability of Regression; 11.5, was J. K., 2013 Quality ankle and bearing Salvation Salvage 131 years amputation Regression 0.0162 significant 83

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx hindfoot coefficient, ly injuries P-value associated with higher time to full weight bearing compared to amputatio n Multivariate Severe open Regression; ankle and adjusted for Regression Ellington, Low hindfoot 2 probability of coefficient, 2.2, Not J. K., 2013 Quality injuries Visual Pain Salvation Salvage 131 years amputation P-value 0.7592 Significant Severe open ankle and Walking adjusted for Multivariate Ellington, Low hindfoot speed > 4 2 probability of regression, 1.8 (0.5- Not J. K., 2013 Quality injuries ft/s Salvation Salvage 131 years amputation CI 6.5) Significant Severe open ankle and adjusted for Multivariate Ellington, Low hindfoot Back to 2 probability of regression, 0.6 (0.2- Not J. K., 2013 Quality injuries work Salvation Salvage 131 years amputation CI 1.9) Significant Multivariate Severe open Regression; ankle and adjusted for Regression Ellington, Low hindfoot Psychosocial 1 probability of coefficient, -3.2, Not J. K., 2013 Quality injuries SIP Salvation Salvage 145 years amputation P-value 0.4347 Significant Salvage Multivariate with free Severe open Overall Salvage w/ Regression; flap/arthr ankle and Sickness free adjusted for Regression odesis is Ellington, Low hindfoot Impact flap/arthrod 1 probability of coefficient, 7.6, associated J. K., 2013 Quality injuries Profile (SIP) Salvation esis 145 years amputation P-value 0.0037 with 84

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx higher overall SIP scores at 1 year Salvage with free flap/arthr odesis is associated Multivariate with Severe open Overall Salvage w/ Regression; higher ankle and Sickness free adjusted for Regression overall SIP Ellington, Low hindfoot Impact flap/arthrod 2 probability of coefficient, 2.5, scores at J. K., 2013 Quality injuries Profile (SIP) Salvation esis 131 years amputation P-value 0.0138 2 years Multivariate Severe open Salvage w/ Regression; ankle and free adjusted for Regression Ellington, Low hindfoot flap/arthrod 1 probability of coefficient, 4.2, Not J. K., 2013 Quality injuries Physical SIP Salvation esis 145 years amputation P-value 0.0854 Significant Multivariate Severe open Salvage w/ Regression; ankle and free adjusted for Regression Ellington, Low hindfoot flap/arthrod 2 probability of coefficient, 3.7, Not J. K., 2013 Quality injuries Physical SIP Salvation esis 131 years amputation P-value 0.1022 Significant Salvage with free flap/arthr odesis is associated with Multivariate higher Severe open Salvage w/ Regression; psychosoc ankle and free adjusted for Regression ial SIP Ellington, Low hindfoot Psychosocial flap/arthrod 1 probability of coefficient, 11.2 scores at J. K., 2013 Quality injuries SIP Salvation esis 145 years amputation P-value (0.0008) 1 year 85

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Salvage with free flap/arthr odesis is associated with Multivariate higher Severe open Salvage w/ Regression; psychosoc ankle and free adjusted for Regression ial SIP Ellington, Low hindfoot Psychosocial flap/arthrod 2 probability of coefficient, 8.4, scores at J. K., 2013 Quality injuries SIP Salvation esis 131 years amputation P-value 0.0125 2 year Multivariate Severe open Salvage w/ Regression; ankle and Re- free adjusted for Regression Ellington, Low hindfoot hospitalizati flap/arthrod 2 probability of coefficient, 0.1, Not J. K., 2013 Quality injuries on Salvation esis 131 years amputation P-value 0.5608 Significant Multivariate Severe open Salvage w/ Regression; ankle and Time to full free adjusted for Regression Ellington, Low hindfoot weight flap/arthrod 2 probability of coefficient, 1.7, Not J. K., 2013 Quality injuries bearing Salvation esis 131 years amputation P-value 0.6599 Significant Multivariate Severe open Salvage w/ Regression; ankle and free adjusted for Regression Ellington, Low hindfoot flap/arthrod 2 probability of coefficient, 3.2, Not J. K., 2013 Quality injuries Visual Pain Salvation esis 131 years amputation P-value 0.5713 Significant Severe open Salvage w/ ankle and Walking free adjusted for Multivariate Ellington, Low hindfoot speed > 4 flap/arthrod 2 probability of regression, 0.4 (0.1- Not J. K., 2013 Quality injuries ft/s Salvation esis 131 years amputation CI 1.0) Significant Severe open Salvage w/ ankle and free adjusted for Multivariate Ellington, Low hindfoot Back to flap/arthrod 2 probability of regression, 1.0 (0.4- Not J. K., 2013 Quality injuries work Salvation esis 131 years amputation CI 2.8) Significant

Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Blast mechanis m of Multivariate injury was Cox predictive Combat- proportional of related open Blast -hazards eventual Dickens, Low calcaneal Mechanism mechanism regression; amputa- J.F., 2013 Quality fractures Amputation of Injury of injury 89 Unclear p-value <0.05 tion Location and larger size of the open wound Multivariate was Cox predictive Combat- Volumetric Location proportional of related open Muscle and larger -hazards eventual Dickens, Low calcaneal Loss/Soft size of the regression; amputa- J.F., 2013 Quality fractures Amputation Tissue Injury open wound 89 Unclear p-value <0.05 tion

Section 13. Degloving Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx >1 debridement, amputation>5 days post injury, ischaemic vascular injury/multi- planar degloving, above-knee Multivariate pts w/ non- amputation, Logistic salvageable Infection in tertiary referral, Regression, Jain, A., Low lower limb Residual Multi-planar smoker, OR, CI, p- 0.6 (0.2- Not 2013 Quality injuries Limb Degloving degloving 40 diabetes value 2.3) Significant

Section 14. Operative Complications Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx age, gender, education, poverty status, race, insurance, personality profile, medical comorbidites, preinjury work status, preinjury job type, mechanism of injury, open fracture type, severity of bone or skin damage, severity of nerve damage, reconstruction or amputation, timing of initial debridement, timing of admission, timing of definite soft tissue coverage, LEAP data; return to work, limb- SIP, walking threatening speed, pain Multiple lower- Operative Major intensity, major logistic O'Toole, R. High extremity Patient Complicatio complicatio 2 complication, regression, Not V., 2008 Quality injures Satisfaction ns n 463 years less anxiety p-value p<0.1 Significant

Section 15. Prosthesis Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx Increasing QoL, no of number of prosthetic special devices ever prosthetic Lower limb received, devices is amputees; Functional No. of amputation Multivariate 5.79 associated mean age of ability specialty- impact rank, Logistic (2.51- with higher 29.4years old; (OIF/OEF type limb-loss level, regression, 13.3), odds of Gailey, Low 57% currently Service prosthetic pain in OR, CI, p- <0.00 functional R., 2010 Quality employed members) Prosthesis devices 169 contralateral leg value 01 ability marriage, education, age, prosthesis, ambulation, stump washing frequency, stump Iraq-Iran war shape, stump Multivariate veterans; length, logistic amputations amputation level, regression, Almassi, Low primarily due to Prosthesis excessive OR, CI, P- Not F., 2010 Quality blast injuries Skin lesion Prosthesis use 335 perspiration value NS Significant Age, education, employment status, marital status, other war-related injuries, history mixture of of civilian and hospitalization, military; prosthetic use, Masoumi unilateral hip side of Multivariate , M., Mod. disarticulation; Prosthetic disarticulation, Logistic Not 2014 Quality avg age 19.54 SF-36 PCS Prosthesis use 76 sports activities Regression NS Significant

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx Age, education, employment status, marital status, other war-related injuries, history mixture of of civilian and hospitalization, military; prosthetic use, Masoumi unilateral hip side of Multivariate , M., Mod. disarticulation; Prosthetic disarticulation, Logistic Not 2014 Quality avg age 19.54 SF-36 MCS Prosthesis use 76 sports activities Regression NS Significant age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of surgeries, type of prosthetic, multiple-limb loss, bilateral Wheelchair Prosthetic limb-loss, Laferrier, Vietnam service use device comorbidities, Multivariate J. Z., Low members w/ (Vietnam satisfaction ambulatory, Logistic Not 2010 Quality lower limb loss Group) Prosthesis and fit 245 highly active regression NS Significant bilateral limb loss, multiple Prosthetic limb loss, Laferrier, OIF/OEF service device cumulative Multivariate J. Z., Low members w/ Wheelchair satisfaction trauma disorder, Logistic Not 2010 Quality lower limb loss use Prosthesis and fit 226 traumatic brain regression NS Significant 91

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, prosthetic device satisfaction and fit, health status, stroke, PTSD, TBI, pantom limb, # of surgeries, type of prosthetic. age, sex, race, weight gain, pain, mental health, QoL, prosthetic device satisfaction, health status, stroke, PTSD, TBI, phantom limb, # of surgeries, type of prosthetic, multiple-limb loss, bilateral Wheelchair type of limb-loss, Laferrier, Vietnam service use prosthetic comorbidities, Multivariate J. Z., Low members w/ (Vietnam device ambulatory, Logistic Not 2010 Quality lower limb loss Group) Prosthesis used 245 highly active regression NS Significant All military Presence Lesser <30 y/o, Multivariate Those with unilateral of Extent of employed in Logistic 1.63 lesser Gunawar amputees; Psychologic Prosthetic army, threatened Regression, (1.08- extent of dena, N., Low average age al Distress - Use with arms, OR, CI, P- 3.96), prosthetic 2007 Quality 26.2 years old; GHQ Scale Prosthesis Outdoors 461 witnessed war value 0.01 use 92

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx land mine most outdoors frequent case of have higher injury odds of psychologic al distress Those with lesser All military extent of unilateral prosthetic amputees; use average age Presence Lesser <30 y/o, Multivariate outdoors 26.2 years old; of Extent of employed in Logistic 2.33 have higher Gunawar land mine most Psychologic Prosthetic army, threatened Regression, (1.53- odds of dena, N., Low frequent case of al Distress - Use with arms, OR, CI, P- 6.08), psychologic 2007 Quality injury BSI Scale Prosthesis Outdoors 461 witnessed war value 0.05 al distress QoL, no of Increasing specialty-type number of prosthetic prosthetic Lower limb devices used, devices is amputees; Functional No of amputation Multivariate associated mean age of ability Prosthetic impact rank, Logistic 1.13 with higher 29.4years old; (OIF/OEF devices limb-loss level, regression, (1.01- odds of Gailey, Low 57% currently Service ever pain in OR, CI, p- 1.27), functional R., 2010 Quality emplyed members) Prosthesis received 169 contralateral leg value 0.03 ability No. of prosthetic devices used Lower limb results in amputees; Functional QoL, amputation Multivariate increased mean age of Ability No. of impact rank, Logistic 2.30 odds of 60.8 years old; (Vietnam Prosthetic limb-loss level, regression, (1.28- higher Gailey, Low 80% currently service Devices no. of surgeries OR, CI, p- 4.14), functional R., 2010 Quality emplyed members) Prosthesis used 178 post limb loss value 0.006 ability

Ref. title Quality Patient Outcome RF Type Full RF N Follow- Confounding Statistic Result Author Characteristics Title name up Time Adjustment Reported Favored Tx bilateral limb loss, multiple limb loss, cumulative trauma disorder, traumatic brain injury, # of combat injuries, age, sex, race, weight gain, pain, mental health, Quality of life, prosthetic device satisfaction and fit, health status, type of stroke, PTSD, TBI, Laferrier, OIF/OEF service prosthetic pantom limb, # Multivariate J. Z., Low members w/ Wheelchair device of surgeries, type Logistic Not 2010 Quality lower limb loss use Prosthesis used 226 of prosthetic. regression NS Significant

Section 16. Segmental Bone Loss Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx mechanism of injury, G/A grade, OTA classification, segmental bone loss, initial bacterial contamination, surveillance Multivariate Type III open Presence of cultures, Logistic Burns, T. Low tibial Need for Segmental segmental surveillance Regression; Not C., 2012 Quality fractures reoperation Bone Loss bone loss 192 organism P-value 0.54 Significant mechanism of injury, G/A grade, OTA classification, segmental bone loss, initial bacterial contamination, surveillance Multivariate Type III open Presence of cultures, Logistic Burns, T. Low tibial Time to Segmental segmental surveillance Regression; Not C., 2012 Quality fractures Union Bone Loss bone loss 192 organism P-value 0.34 Significant

Section 17. Volumetric Muscle Loss Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx Treatment, age, gender, race, Soft-tissue education, injury is poverty status, associated smoking status, with legal increased LEAP Study involvement, Multivariate odds of patients; Physical SIP self-efficacy, Logistic high SIP MacKenzie Mod. Unilateral Sub-score of Volumetric Soft-tissue 84 probability of Regression; 3.1, score at , E. J., 2005 Quality injuries only. >=5 points Muscle Loss injury 397 mon. amputation OR, P-value <0.05 84 mon.. Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study involvement, Multivariate patients; Physical SIP self-efficacy, Logistic MacKenzie Mod. Unilateral Sub-score of Volumetric Soft-tissue 84 probability of Regression; Not , E. J., 2005 Quality injuries only. >=20 points Muscle Loss injury 397 mon. amputation OR 1.0 Significant Treatment, age, gender, race, education, poverty status, smoking status, legal LEAP Study Psychosocial involvement, Multivariate patients; SIP Sub- self-efficacy, Logistic MacKenzie Mod. Unilateral score of >=5 Volumetric Soft-tissue 84 probability of Regression; Not , E. J., 2005 Quality injuries only. points Muscle Loss injury 397 mon. amputation OR 1.2 Significant Treatment, age, MacKenzie Mod. LEAP Study Psychosocial Volumetric Soft-tissue 84 gender, race, Multivariate Not , E. J., 2005 Quality patients; SIP Sub- Muscle Loss injury 397 mon. education, Logistic 0.9 Significant

Excluded Literature Authors Article Title Year Expanded Periodical Recommendation(s) Reason for Exclusion Title Naschitz, J. E.; Lenger, R. Why traumatic leg amputees 2008 Qjm Systematic Reviews Systematic Review are at increased risk for cardiovascular diseases Edwards, D. S.; Phillip, R. What Is the Magnitude and 2015 Clin Orthop Relat Res Patient/Injury factors for LS Doesn't address question D.; Bosanquet, N.; Bull, A. Long-term Economic Cost of or Amp of interest; sys review M.; Clasper, J. C. Care of the British Military Afghanistan Amputee Cohort? Lazzarini, P. A.; O'Rourke, What are the key conditions 2012 J Foot Ankle Res Immediate amputation Wrong population S. R.; Russell, A. W.; Clark, associated with lower limb factors; Patient/Injury D.; Kuys, S. S. amputations in a major factors for LS or Amp Australian teaching hospital? Jovanovic, S.; Wartime amputations 1999 Mil Med Patient/Injury factors for LS No usable data Wertheimer, B.; Zelic, Z.; or Amp Getos, Z. Bumbasirevic, M.; Tomic, War-related infected tibial 2010 Arch Orthop Trauma Environmental factors for LS No controlled comparison; S.; Lesic, A.; Milosevic, I.; nonunion with bone and soft- Surg or Amp No relevant RFs Atkinson, H. D. tissue loss treated with bone transport using the Ilizarov method Nemec, B.; Santic, V.; War wounds to the foot 2000 Mil Med Environmental factors for LS No controlled comparison; Matovinovic, D.; Gulan, G. or Amp No relevant RFs Davila, S.; Mikulic, D. War injuries of the talus 2001 Mil Med Patient/Injury factors for LS No usable data or Amp Radonic, V.; Baric, D.; War injuries of the femoral 1997 Cardiovasc Surg Immediate amputation case series Giunio, L.; Bill, B.; artery and vein: a report on 67 factors Kovacevic, H.; Sapunar, D. cases Nanobashvili, J.; Kopadze, War injuries of major extremity 2003 World J Surg Immediate amputation Mixed population T.; Tvaladze, M.; arteries factors Buachidze, T.; Nazvlishvili, G. Hendershot, B. D.; Walking speed differentially 2018 J Biomech Environmental factors for LS No usable data Shojaei, I.; Acasio, J. C.; alters spinal loads in persons or Amp Dearth, C. L.; Bazrgari, B. with traumatic lower limb amputation Van de Meent, H.; Walking ability and quality of 2013 Arch Phys Med Environmental factors for LS mixed etiology; no Hopman, M. T.; Frolke, J. life in subjects with Rehabil or Amp controlled comparison P. transfemoral amputation: a comparison of osseointegration with socket prostheses Corona, B. T.; Rivera, J. C.; Volumetric muscle loss leads to 2015 J Rehabil Res Dev Cost Analysis Owens, J. G.; Wenke, J. C.; permanent disability following Rathbone, C. R. extremity trauma Bruins, R.; Bruins, M.; Vocational reintegration after a 2003 Prosthetics and Environmental factors for LS No Controlled Geertzen, J. H. B.; lower limb amputation: A Orthotics or Amp Comparison; Mixed Groothoff, J. W.; qualitative study International Etiology Schoppen, T. Jamali, A. R.; Mehboob, G. Venous trauma 1998 Journal of the Immediate amputation mixed extremity College of Physicians factors and Surgeons Pakistan Hannon, M.; Tadlock, M. Venous thromboembolism after 2016 American Journal of Patient/Injury factors for LS Mixed population D.; Melcer, T.; Walker, J.; traumatic amputation: an Surgery or Amp Bandle, J.; Nieses, K.; analysis of 366 combat Galarneau, M. casualties Yajima, H.; Tamai, S.; Vascularized composite tissue 2002 Microsurgery Patient/Injury factors for LS No controlled comparison Kobata, Y.; Murata, K.; transfers for open fractures with or Amp Fukui, A.; Takakura, Y.; massive soft-tissue defects in Tomaino, M. the lower extremities Sfeir, R. E.; Khoury, G. S.; Vascular trauma to the lower 1995 Cardiovasc Surg Immediate amputation very low quality Kenaan, M. K. extremity: the Lebanese war factors experience Lakhwani, M. N.; Gooi, B. Vascular trauma in Penang and 2002 Med J Malaysia Immediate amputation mixed extremity H.; Barras, C. D. Kuala Lumpur Hospitals factors; Patient/Injury factors for LS or Amp Macedo, F. I.; Sciarretta, J. Vascular Reconstruction Is Not 2016 Ann Vasc Surg Patient/Injury factors for LS no controlled comparison; D.; Chausse, S.; Sleeman, Warranted in Most Civilian or Amp very low quality D.; Pizano, L. R.; Namias, Traumatic Shank Vascular N. Injuries Sherif, A. A. Vascular injuries: experience 1992 Int Surg Immediate amputation case series during the Afghanistan War factors

Soares, L. T.; Bastos, C. C.; Vascular injuries in the state of 2015 Jornal Vascular Patient/Injury factors for LS Mixed population Junior, A. K.; Pereira, A. J. ParÃ¡, Brazil, 2011-2013 and Brasileiro or Amp F. their relation with demographic and clinical variables Kulkarni, M. S.; Aroor, M. Variables affecting functional 2018 Injury Patient/Injury factors for LS No usable data; N.; Vijayan, S.; Shetty, S.; outcome in floating knee or Amp Tripathy, S. K.; Rao, S. K. injuries Labler, L.; Keel, M.; Trentz, Vacuum-assisted closure 2004 European Journal of Patient/Injury factors for LS No controlled comparison O. (V.A.C.Â®) for temporary Trauma or Amp coverage of soft-tissue injury in type III open fracture of lower extremities Labler, L.; Trentz, O. The use of vacuum assisted 2007 Langenbecks Arch Patient/Injury factors for LS Case series closure (VAC) in soft tissue Surg or Amp injuries after high energy pelvic trauma Joseph, T. N.; Myerson, M. Use of talectomy in modern foot 2004 Foot and Ankle Patient/Injury factors for LS review S. and ankle surgery Clinics or Amp; Environmental factors for LS or Amp Vertrees, A.; Fox, C. J.; The use of prosthetic grafts in 2009 J Trauma Patient/Injury factors for LS No RF of interest Quan, R. W.; Cox, M. W.; complex military vascular or Amp Adams, E. D.; Gillespie, D. trauma: a limb salvage strategy L. for patients with severely limited autologous conduit Polyzois, V. D.; Galanakos, The use of Papineau technique 2011 Diabet Foot Ankle No usable data S. P.; Tsiampa, V. A.; for the treatment of diabetic Papakostas, I. D.; Kouris, and non-diabetic lower N. K.; Avram, A. M.; extremity pseudoarthrosis and Papalois, A. E.; Ignatiadis, chronic osteomyelitis I. A. Dedmond, B. T.; Kortesis, The use of negative-pressure 2007 J Orthop Trauma Patient/Injury factors for LS *wound management* B.; Punger, K.; Simpson, J.; wound therapy (NPWT) in the or Amp Argenta, J.; Kulp, B.; temporary treatment of soft- Morykwas, M.; Webb, L. tissue injuries associated with X. high-energy open tibial shaft fractures

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Rezzadeh, K. S.; Nojan, M.; The use of negative pressure 2015 J Surg Res Patient/Injury factors for LS No controlled comparisons Buck, A.; Li, A.; Vardanian, wound therapy in severe open or Amp A.; Crisera, C.; Festekjian, lower extremity fractures: J.; Jarrahy, R. identifying the association between length of therapy and surgical outcomes Ulusal, A. E.; Lin, C. H.; Lin, The use of free flaps in the 2008 Plast Reconstr Surg Patient/Injury factors for LS Case Series Y. T.; Ulusal, B. G.; Yazar, management of type IIIB open or Amp S. calcaneal fractures Zarutsky, E.; Rush, S. M.; The use of circular wire external 2005 Journal of Foot and Patient/Injury factors for LS mixed etiology; case series Schuberth, J. M. fixation in the treatment of Ankle Surgery or Amp salvage ankle arthrodesis Castillo, R. C.; MacKenzie, Use and perceived need of 2005 Arch Phys Med Environmental factors for LS Prospective univariate; E. J.; Webb, L. X.; Bosse, physical therapy following Rehabil or Amp very low quality M. J.; Avery, J. severe lower-extremity trauma Miller, M.; Wong, W. K.; Upper-Arm Anthropometry: An 2008 Archives of Physical Patient/Injury factors for LS mixed etiology Wu, J.; Cavenett, S.; Alternative Indicator of Medicine and or Amp Daniels, L.; Crotty, M. Nutritional Health to Body Mass Rehabilitation Index in Unilateral Lower- Extremity Amputees? Schlickewei, W.; Kuner, E. Upper and lower limb fractures 1992 J Bone Joint Surg Br Immediate amputation mixed extremity H.; Mullaji, A. B.; Gotze, B. with concomitant arterial injury factors Tomaino, M. M.; Bowen, Unsatisfactory outcome after 1998 Am J Orthop (Belle Immediate amputation Case Series C. V. lower limb salvage: decision- Mead NJ) factors; Patient/Injury making pitfalls factors for LS or Amp Bennett, P. M.; Sargeant, Unilateral lower limb loss 2013 Bone Joint J Patient/Injury factors for LS no RF of interest I. D.; Midwinter, M. J.; following combat injury: or Amp Penn-Barwell, J. G. medium-term outcomes in British military amputees Mehta, S. S.; Rees, K.; Understanding risks and 2014 Indian J Orthop Systematic Reviews Systematic Review Cutler, L.; Mangwani, J. complications in the management of ankle fractures Ritchie, A. J.; Small, J. O.; Type III tibial fractures in the 1991 Injury Immediate amputation wrong age range Hart, N. B.; Mollan, R. A. elderly: results of 23 fractures in factors 20 patients

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Siddique, M. K.; Bhatti, A. A two-year experience of 2013 J Pak Med Assoc Patient/Injury factors for LS Mixed etiology; Mixed M. treating vascular trauma in the or Amp population extremities in a military hospital Leclerc, B.; Boyer, E.; Two-team management of 2018 Orthop Traumatol Immediate amputation mixed extremity Menu, G.; Leclerc, G.; vascular injuries concomitant Surg Res factors Sergent, P.; Ducroux, E.; with osteo-articular injuries in Salomon Du Mont, L.; 36 patients over six years Garbuio, P.; Rinckenbach, S.; Obert, L. Paudel, B.; Shrestha, B. K.; Two faces of major lower limb 2005 Kathmandu Univ Environmental factors for LS No Controlled Banskota, A. K. amputations Med J (KUMJ) or Amp Comparison; does not address question of interest Richmond, B. K.; Judhan, Trends and Outcomes in the 2017 Am Surg Immediate amputation mixed extremity R.; Sherrill, W.; Yacoub, Operative Management of factors M.; AbuRahma, A. F.; Traumatic Vascular Injuries: A Knackstedt, K.; Chumbe, J. Comparison of Open versus T.; Samanta, D.; Endovascular Approaches Thompson, S. N. Armstrong, P. J.; Franklin, Treatment of vascular injuries in 2003 Operative Patient/Injury factors for LS Review D. P. the multiple-ligament-injured Techniques in Sports or Amp knee Medicine Langworthy, M. J.; Smith, Treatment of the mangled lower 2004 Clin Orthop Relat Res Systematic Reviews review J. M.; Gould, M. extremity after a terrorist blast injury Rodriguez, C. J.; Tribble, D. Treatment of Suspected 2018 Mil Med Patient/Injury factors for LS Review R.; Malone, D. L.; Murray, Invasive Fungal Infection in War or Amp C. K.; Jessie, E. M.; Khan, Wounds M.; Fleming, M. E.; Potter, B. K.; Gordon, W. T.; Shackelford, S. A. Karger, C.; Kishi, T.; Treatment of posttraumatic 2012 Orthop Traumatol Patient/Injury factors for LS No controlled comparisons Schneider, L.; Fitoussi, F.; bone defects by the induced Surg Res or Amp ; Masquelet, A. C. membrane technique Mack, A. W.; Freedman, B. Treatment of open proximal 2013 Journal of Bone and Patient/Injury factors for LS No controlled comparisons A.; Groth, A. T.; Kirk, K. L.; femoral fractures sustained in Joint Surgery - Series or Amp combat A 102

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Covey, D. C.; Peterson, D. Treatment of musculoskeletal 1995 Techniques in Immediate amputation very low quality A. blast wounds at a navy field Orthopaedics factors hospital during the Balkans war Zhao, L.; Jie, Q.; Ye, M.; Treatment of limb arterial 2002 Chin J Traumatol Patient/Injury factors for LS No controlled comparisons Liu, Q.; Huang, Y. injuries caused by traffic or Amp accidents Krappinger, D.; Treatment of large 2013 Arch Orthop Trauma Patient/Injury factors for LS no RF of interest Irenberger, A.; Zegg, M.; posttraumatic tibial bone Surg or Amp Huber, B. defects using the Ilizarov method: a subjective outcome assessment Kumar, P.; Singh, G. K.; Treatment of grade IIIB opens 2007 Kathmandu Univ Patient/Injury factors for LS no RF of interest Bajracharya, S. tibial fracture by Ilizarov hybrid Med J (KUMJ) or Amp external fixator Turen, C. H.; DiStasio, A. J. Treatment of grade IIIB and 1994 Orthop Clin North Immediate amputation review grade IIIC open tibial fractures Am factors; Patient/Injury factors for LS or Amp Starr, A. J.; Hunt, J. L.; Treatment of femur fracture 1996 J Trauma Patient/Injury factors for LS No controlled comparisons Reinert, C. M. with associated vascular injury or Amp Parekh, A. A.; Smith, W. Treatment of distal femur and 2008 J Trauma Patient/Injury factors for LS Mixed etiology R.; Silva, S.; Agudelo, J. F.; proximal tibia fractures with or Amp Williams, A. E.; Hak, D.; external fixation followed by Morgan, S. J. planned conversion to internal fixation Delimar, D.; Klobucar, H.; Treatment of defect 2001 Acta Chir Orthop Environmental factors for LS No Controlled Comparison Jelic, M.; Cicak, N.; pseudoarthroses with bone Traumatol Cech or Amp Korzinek, K. segment transport Junnila, J.; Repo, J. P.; Treatment of compound tibial 2015 J Reconstr Microsurg Patient/Injury factors for LS Mixed etiology Mustonen, A.; Tukiainen, fracture with free or Amp E. J. osteomuscular latissimus dorsi scapula flap

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Repo, J. P.; Barner- Treatment of compound tibia 2016 J Plast Reconstr Patient/Injury factors for LS mixed etiology; no RF of Rasmussen, I.; Roine, R. fracture with microvascular Aesthet Surg or Amp interest P.; Sintonen, H.; latissimus dorsi flap and the Tukiainen, E. J. Ilizarov technique: A cross- sectional study of long-term outcomes Liu, L.; Tang, X.; Pei, F. X.; Treatment for 332 cases of 2010 Chin J Traumatol Patient/Injury factors for LS case series Tu, C. Q.; Song, Y. M.; lower leg fracture in "5.12" or Amp Huang, F. G.; Yang, T. F.; Wenchuan earthquake Wang, G. L.; Fang, Y.; Zhang, H.; Zhong, G. Gavrankapetanovic, F.; Treatment evaluation of 2001 Acta Med Croatica Patient/Injury factors for LS not best available; very Gavrankapetanovic, I.; hindfoot injuries caused by or Amp low quality Biscevic, M. pressure activated explosive devices in the war and peace time Verdant, A.; Gaffiero, P. The traumatized ischemic lower 1995 Can J Surg No usable data; limb: a search for the optimal treatment Shapiro, M. J.; Luchtefeld, Traumatic train injuries 1994 Am J Emerg Med Immediate amputation mixed extremity; No W. B.; Durham, R. M.; factors; Patient/Injury Controlled Comparison Mazuski, J. E. factors for LS or Amp Yasar, T.; Inci, I.; Furtun, Traumatic pseudoaneurysms of 1993 Vascular Surgery Patient/Injury factors for LS *Mixed population (lower K.; Ozgen, G. peripheral arteries and their or Amp and upper extremities) surgical management Herzog, G. A.; Serrano- Traumatic Proximal Tibiofibular 2015 J Orthop Trauma Immediate amputation insufficient data; Riera, R.; Sagi, H. C. Dislocation: A Marker of factors; Patient/Injury Severely Traumatized factors for LS or Amp Extremities Kobayashi, L.; Inaba, K.; Traumatic limb amputations at a 2011 Eur J Trauma Emerg Patient/Injury factors for LS *mixed-upper & lower Barmparas, G.; Criscuoli, level I trauma center Surg or Amp extremity* M.; Lustenberger, T.; Talving, P.; Lam, L.; Demetriades, D. Khoury, G.; Sfeir, R.; Traumatic arteriovenous 1994 Eur J Vasc Surg Patient/Injury factors for LS Mixed population Nabbout, G.; Jabbour- fistulae: "the Lebanese war or Amp Khoury, S.; Fahl, M. experience"

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Hull, J. B. Traumatic amputation by 1992 Br J Surg Patient/Injury factors for LS Mixed etiology explosive blast: pattern of injury or Amp in survivors Wozasek, G. E.; Moser, K. Trauma involving the proximal 1991 Archives of Patient/Injury factors for LS Incorrect pts population D.; Haller, H.; Capousek, tibial epiphysis Orthopaedic and or Amp M. Trauma Surgery Lo, C. H.; Leung, M.; Trauma centre experience: flap 2007 ANZ J Surg Patient/Injury factors for LS No controlled comparisons Baillieu, C.; Chong, E. W.; reconstruction of traumatic or Amp Cleland, H. lower limb injuries Dougherty, P. J. Transtibial amputees from the 2001 J Bone Joint Surg Am Patient/Injury factors for LS prospective univariate; Vietnam War. Twenty-eight- or Amp very low quality year follow-up Ring, D.; Jupiter, J. B.; Toh, Transarticular bony defects 1999 Plast Reconstr Surg Patient/Injury factors for LS *mixed-upper & lower S. after trauma and sepsis: or Amp extremity* arthrodesis using vascularized fibular transfer Singer, G.; Thordarson, D. Train-versus-pedestrian injuries. 1994 Orthop Rev Patient/Injury factors for LS *mixed-upper & lower Orthopaedic management or Amp extremity* Moore, T. J.; Wilson, J. R.; Train versus pedestrian 1991 South Med J Patient/Injury factors for LS No controlled comparisons Hartman, M. accidents or Amp Kauvar, D. S.; Miller, D.; Tourniquet use is not associated 2018 J Trauma Acute Care Immediate amputation no RF of interest; Walters, T. J. with limb loss following military Surg factors lower extremity arterial trauma King, D. R.; Larentzakis, A.; Tourniquet use at the Boston 2015 J Trauma Acute Care Immediate amputation prospective univariate; No Ramly, E. P. Marathon bombing: Lost in Surg factors Controlled Comparison translation Lovric, Z.; Lehner, V.; Tourniquet occlusion technique 1997 J Cardiovasc Surg Immediate amputation case series; no usable data Wertheimer, B.; Kosic- for lower extremity artery (Torino) factors Lovric, L. reconstruction in war wound Pozo, J. L.; Powell, B.; The timing of amputation for 1990 J Bone Joint Surg Br Patient/Injury factors for LS No controlled comparisons Andrews, B. G.; Hutton, P. lower limb trauma or Amp A.; Clarke, J. Jeng, C. L.; Campbell, J. T.; Tibiotalocalcaneal arthrodesis 2013 Foot Ankle Int Patient/Injury factors for LS Mixed etiology Tang, E. Y.; Cerrato, R. A.; with bulk femoral head allograft or Amp Myerson, M. S. for salvage of large defects in the ankle 105

Wukich, D. K.; Mallory, B. Tibiotalocalcaneal Arthrodesis 2015 Journal of Foot and Patient/Injury factors for LS Incorrect population R.; Suder, N. C.; Rosario, Using Retrograde Ankle Surgery or Amp B. L. Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus Scaglione, M.; Celli, F.; Tibial pilon fractures treated 2018 Musculoskelet Surg Patient/Injury factors for LS Mixed etiology Casella, F.; Fabbri, L. with hybrid external fixator: or Amp analysis of 75 cases Robinson, C. M.; Tibial fractures with bone loss 1995 J Bone Joint Surg Br Environmental factors for LS <10 subjects per group McLauchlan, G.; Christie, treated by primary reamed or Amp J.; McQueen, M. M.; intramedullary nailing Court-Brown, C. M. Levy, A. S.; Bromberg, J.; Tibia fractures produced from 1994 J Orthop Trauma Patient/Injury factors for LS No controlled comparisons Jasper, D. the impact of a baseball bat or Amp Albino, F. P.; Seidel, R.; Through knee amputation: 2014 Arch Plast Surg Patient/Injury factors for LS Mixed etiology Brown, B. J.; Crone, C. G.; technique modifications and or Amp Attinger, C. E. surgical outcomes Littman, A. J.; Bouldin, E. This is your new normal: A 2017 Disabil Health J Environmental factors for LS No controlled comparison; D.; Haselkorn, J. K. qualitative study of barriers and or Amp No relevant RFs facilitators to physical activity in Veterans with lower extremity loss Krueger, C. A.; Wenke, J. Ten years at war: 2012 J Trauma Acute Care Patient/Injury factors for LS *mixed-upper & lower C.; Ficke, J. R. comprehensive analysis of Surg or Amp extremity* amputation trends Oliver, J. C.; Bekker, W.; A ten year review of civilian iliac 2012 Eur J Vasc Endovasc Immediate amputation very low quality Edu, S.; Nicol, A. J.; vessel injuries from a single Surg factors Navsaria, P. H. trauma centre Bobroff, G. D.; Gold, S.; Ten year experience with use of 2003 Bull Hosp Jt Dis Patient/Injury factors for LS no controlled comparisons Zinar, D. Ilizarov bone transport for tibial or Amp defects Magee, T. R.; Collin, J.; A ten year audit of surgery for 1996 Eur J Vasc Endovasc Patient/Injury factors for LS case series Hands, L. J.; Gray, D. W.; vascular trauma in a British Surg or Amp Roake, J. teaching hospital Oliver, J. C.; Gill, H.; Nicol, Temporary vascular shunting in 2013 S Afr J Surg Immediate amputation Doesn't address question A. J.; Edu, S.; Navsaria, P. vascular trauma: a 10-year factors of interest; mixed H. extremity 106

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Jarvis, H. L.; Bennett, A. Temporal Spatial and Metabolic 2017 Arch Phys Med Environmental factors for LS no comparison of interest N.; Twiste, M.; Phillip, R. Measures of Walking in Highly Rehabil or Amp D.; Etherington, J.; Baker, Functional Individuals With R. Lower Limb Amputations Yakuboff, K. P.; Stern, P. Technical successes and 1990 Microsurgery Patient/Injury factors for LS case series J.; Neale, H. W. functional failures after free or Amp tissue transfer to the tibia Hammer, R.; Lidman, D.; Team approach to tibial 1992 Acta Orthop Scand Environmental factors for LS No relevant RFs Nettelblad, H.; Ostrup, L. fracture. 37 consecutive type III or Amp cases reviewed after 2-10 years Kaufman, K. R.; Wyatt, M. Task-specific fall prevention 2014 Clin Orthop Relat Res Environmental factors for LS no comparison group P.; Sessoms, P. H.; training is effective for or Amp Grabiner, M. D. warfighters with transtibial amputations Butler, K.; Bowen, C.; A systematic review of the key 2014 J Tissue Viability Systematic Reviews Systematic Review Hughes, A. M.; Torah, R.; factors affecting tissue viability Ayala, I.; Tudor, J.; and rehabilitation outcomes of Metcalf, C. D. the residual limb in lower extremity traumatic amputees Saddawi-Konefka, D.; Kim, A systematic review of 2008 Plast Reconstr Surg Systematic Reviews systematic review H. M.; Chung, K. C. outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia Malcolm-Smith, N. A. Syme and his amputation 2004 Surgeon Immediate amputation Mixed etiology factors; Patient/Injury factors for LS or Amp; Environmental factors for LS or Amp Fufa, D. T.; Lin, C. H.; Lin, Survival and secondary surgery 2014 J Reconstr Microsurg Immediate amputation No Controlled Comparison Y. T.; Hsu, C. C.; Lin, C. H. following lower extremity factors replantation

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Ersoy, A.; Yavuz, M.; Usta, Survival analysis of the factors 2003 Clin Nephrol Immediate amputation mixed extremity M.; Ercan, I.; Aslanhan, I.; affecting in mortality in injured factors Gullulu, M.; Kurt, E.; Emir, patients requiring dialysis due to G.; Dilek, K.; Yurtkuran, acute renal failure during the M. Marmara earthquake: survivors vs non-survivors Wolosker, N.; Guadencio, Surgical treatment of 1996 Sao Paulo Med J Patient/Injury factors for LS case series A.; Kuzniec, S.; Rosoky, R. noniatrogenic trauma of the or Amp A.; Kalume, C.; Neves, C. femoral arteries A.; Aun, R.; Langer, B. Georgiadis, G. S.; Surgical treatment of femoral 2005 ANZ J Surg Systematic Reviews *systematic review; Lazarides, M. K.; artery infected false aneurysms references reviewed* Polychronidis, A.; in drug abusers Simopoulos, C. Schon, L. C.; Anderson, C. Surgical treatment of chronic 2001 Clin Orthop Relat Res Patient/Injury factors for LS Mixed etiology D.; Easley, M. E.; Lam, P. lower extremity neuropathic or Amp W.; Trnka, H. J.; Lumsden, pain D. B.; Levin, G.; Shanker, J. Liu, K.; Tang, T.; Wang, A.; Surgical revision for stump 2015 BMC Musculoskelet Environmental factors for LS No controlled comparisons Cui, S. problems after traumatic above- Disord or Amp ; ankle amputations of the lower extremity King, J. J., 3rd; Cerynik, D. Surgical outcomes after 2009 Knee Surg Sports Patient/Injury factors for LS Too few pts L.; Blair, J. A.; Harding, S. traumatic open knee dislocation Traumatol Arthrosc or Amp P.; Tom, J. A. Demirkilic, U.; Kuralay, E.; Surgical approach to military 1998 Cardiovasc Surg Patient/Injury factors for LS *mixed-upper & lower Yilmaz, A. T.; Ozal, E.; vascular injuries or Amp extremity* Tatar, H.; Ozturk, O. Y. O'Toole, R. V.; Castillo, R. Surgeons and their patients 2009 J Orthop Trauma Patient/Injury factors for LS No usable data C.; Pollak, A. N.; disagree regarding cosmetic and or Amp MacKenzie, E. J.; Bosse, overall outcomes after surgery M. J. for high-energy lower extremity trauma Nikolic, D. K.; Jovanovic, Supracondylar missile fractures 2002 Injury Immediate amputation case series Z.; Turkovic, G.; Vulovic, of the femur factors R.; Mladenovic, M.

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Karpman, R. R.; Del Mar, Supracondylar femoral fractures 1995 Clin Orthop Relat Res Immediate amputation wrong age range N. B. in the frail elderly. Fractures in factors need of treatment Kim, C. Y.; Kim, Y. H. Supermicrosurgical 2012 Plast Reconstr Surg Patient/Injury factors for LS No high-energy trauma reconstruction of large defects or Amp on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps Schandelmaier, P.; Superior results of tibial rodding 1997 Clin Orthop Relat Res Patient/Injury factors for LS no comparison of interest Krettek, C.; Rudolf, J.; versus external fixation in grade or Amp Kohl, A.; Katz, B. E.; 3B fractures Tscherne, H. Celikoz, B.; Sengezer, M.; Subacute reconstruction of 2005 Microsurgery Environmental factors for LS No controlled comparison; Isik, S.; Turegun, M.; lower leg and foot defects due or Amp No relevant RFs Deveci, M.; Duman, H.; to high velocity-high energy Acikel, C.; Nisanci, M.; injuries caused by gunshots, Ozturk, S. missiles, and land mines Dutronc, H.; Gobet, A.; Stump infections after major 2013 Med Mal Infect Patient/Injury factors for LS Incorrect population Dauchy, F. A.; Klotz, R.; lower-limb amputation: a 10- or Amp Cazanave, C.; Garcia, G.; year retrospective study Lafarie-Castet, S.; Fabre, T.; Dupon, M. Sahu, A.; Gupta, R.; Sagar, A study of psychiatric 2017 Ind Psychiatry J Immediate amputation mixed extremity S.; Kumar, M.; Sagar, R. comorbidity after traumatic factors; Patient/Injury limb amputation: A neglected factors for LS or Amp entity Polyzois, V. D.; Strategies for managing bone 2014 Clin Podiatr Med Patient/Injury factors for LS Review Stathopoulos, I. P.; defects of the lower extremity Surg or Amp Lampropoulou-Adamidou, K.; Vasiliadis, E. S.; Vlamis, J.; Pneumaticos, S. G. Aftabuddin, M.; Islam, N.; The status of lower-limb 1997 Surg Today Immediate amputation mixed etiology; Jafar, M. A.; Haque, I. amputation in Bangladesh: a 6- factors; Patient/Injury insufficient data year review factors for LS or Amp Kim, Y. C.; Park, C. I.; Kim, Statistical analysis of 1996 Prosthet Orthot Int Immediate amputation Mixed population; wrong D. Y.; Kim, T. S.; Shin, J. C. amputations and trends in factors age range; Korea

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Isakov, E.; Mizrahi, J.; Standing sway and weight- 1992 Arch Phys Med Immediate amputation non-trauma Ring, H.; Susak, Z.; Hakim, bearing distribution in people Rehabil factors N. with below-knee amputations Kumar, A. R. Standard wound coverage 2006 J Am Acad Orthop Patient/Injury factors for LS *mixed-upper & lower techniques for extremity war Surg or Amp extremity* injury Zoller, S. D.; Cao, L. A.; Staged reconstruction of 2017 Injury Patient/Injury factors for LS Too few pts Smith, R. A.; Sheppard, diaphyseal fractures with or Amp W.; Lord, E. L.; Hamad, C. segmental defects: Surgical and D.; Ghodasra, J. H.; Lee, patient-reported outcomes C.; Jeffcoat, D. Sirkin, M.; Sanders, R.; A staged protocol for soft tissue 2004 J Orthop Trauma Patient/Injury factors for LS No controlled comparisons DiPasquale, T.; Herscovici, management in the treatment or Amp D., Jr. of complex pilon fractures Tejwani, N. C.; Achan, P. Staged management of high- 2004 Bull Hosp Jt Dis Systematic Reviews review energy proximal tibia fractures Peirano, A. H.; Franz, R. Spirituality and quality of life in 2012 Int J Angiol Immediate amputation mixed extremity; mixed W. limb amputees factors etiology

Kovac, I.; Medved, V.; Spatial, temporal and kinematic 2010 Coll Antropol no comparison of interest Ostojic, L. characteristics of traumatic transtibial amputees' gait Choudry, U.; Moran, S.; Soft-tissue coverage and 2008 Plast Reconstr Surg Patient/Injury factors for LS no controlled comparison Karacor, Z. outcome of gustilo grade IIIB or Amp midshaft tibia fractures: a 15- year experience Leland, H. A.; Rounds, A. Soft tissue reconstruction and 2018 Microsurgery Patient/Injury factors for LS No controlled comparisons D.; Burtt, K. E.; Gould, D. salvage of infected fixation or Amp J.; Marecek, G. S.; Alluri, hardware in lower extremity R. K.; Patel, K. M.; Carey, trauma J. N. Kamath, J. B.; Shetty, M. Soft tissue coverage in open 2012 Indian J Orthop Environmental factors for LS No controlled comparison; S.; Joshua, T. V.; Kumar, fractures of tibia or Amp No relevant RFs A.; Harshvardhan,; Naik, D. M.

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De Boer, A. S.; Van Soft tissue complications and 2018 Injury Immediate amputation No RF of interest Lieshout, E. M. M.; Van 't timing of surgery in patients factors Land, F.; Misselyn, D.; with a tongue-type displaced Schepers, T.; Den Hartog, intra-articular calcaneal D.; Verhofstad, M. H. J. fracture: An international retrospective cohort study Messinger, S.; Social relationships in 2018 J Rehabil Med Environmental factors for LS No Controlled Comparison Bozorghadad, S.; rehabilitation and their impact or Amp Pasquina, P. on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center Court-Brown, C. M.; Social deprivation and adult 2007 Injury Patient/Injury factors for LS unclear etiology; Brydone, A. tibial diaphyseal fractures or Amp

Greenhagen, R. M.; Smoking cessation: the role of 2010 Foot Ankle Spec review Johnson, A. R.; the foot and ankle surgeon Bevilacqua, N. J. Ring, J.; Shoaib, A.; Shariff, Smoking cessation advice in 2017 Injury Patient/Injury factors for LS Mixed etiology R. limb reconstruction: An or Amp opportunity not to be missed Polfer, E. M.; Tintle, S. M.; Skin Grafts for Residual Limb 2015 Plast Reconstr Surg Patient/Injury factors for LS *mixed-upper & lower Forsberg, J. A.; Potter, B. Coverage and Preservation of or Amp extremity* K. Amputation Length Almassi, F.; Mousavi, B.; Skin disorders associated with 2009 Pak J Biol Sci no comparison of interest Masumi, M.; Souroush, M. bilateral lower extremity R.; Honari, G. amputation Lin, C. H.; Mardini, S.; Lin, Sixty-five clinical cases of free 2004 J Trauma Patient/Injury factors for LS Mixed etiology and Y. T.; Yeh, J. T.; Wei, F. C.; tissue transfer using long or Amp population Chen, H. C. arteriovenous fistulas or vein grafts Mathews, J. A.; Ward, J.; Single-stage orthoplastic 2015 Injury Environmental factors for LS No controlled comparison; Chapman, T. W.; Khan, U. reconstruction of Gustilo- or Amp No relevant RFs M.; Kelly, M. B. Anderson Grade III open tibial fractures greatly reduces infection rates

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Balakrishnan, T. M.; Single stage reconstruction of 2018 Injury Patient/Injury factors for LS case series Sridhar, S.; Jaganmohan, post traumatic and post or Amp J.; Rajan, H. K. G.; excisional composite perigenual Vaidyanathan, S. defects using chimeric pedicled propelled osteomyocutaneous fibula flap Nambi, G. I.; Salunke, A. Single stage management of 2017 Chin J Traumatol Patient/Injury factors for LS case series A.; Thirumalaisamy, S. G.; Gustilo type III A/B tibia or Amp Babu, V. L.; Baskaran, K.; fractures: Fixed with nail & Janarthanan, T.; Boopathi, covered with fasciocutaneous K.; Chen, Y. S. flap Robert Rozbruch, S.; Simultaneous treatment of tibial 2006 J Orthop Trauma Patient/Injury factors for LS no controlled comparisons Weitzman, A. M.; Tracey bone and soft-tissue defects or Amp Watson, J.; Freudigman, with the Ilizarov method P.; Katz, H. V.; Ilizarov, S. Wu, C. C.; Shih, C. H. Simultaneous bilateral femoral 1992 J Trauma Patient/Injury factors for LS No controlled comparison shaft fractures or Amp Tomaszewski, P. K.; Simulated bone remodeling 2012 J Mech Behav Environmental factors for LS No Controlled Verdonschot, N.; Bulstra, around two types of Biomed Mater or Amp Comparison; Population S. K.; Rietman, J. S.; osseointegrated implants for n<10 Verkerke, G. J. direct fixation of upper-leg prostheses Delhey, P.; Huber, S.; SIGNIFICANCE of TRAUMATIC 2015 Shock Patient/Injury factors for LS *mixed-upper & lower Hanschen, M.; HÃ¤berle, MACROAMPUTATION in or Amp extremity* S.; Trentzsch, H.; Deiler, SEVERELY INJURED PATIENTS: S.; Van Griensven, M.; AN ANALYSIS of the Biberthaler, P.; Lefering, TRAUMAREGISTER DGUA R.; Huber-Wagner, S. Porter, J. M.; Ivatury, R. R. Should trauma surgeons render 2001 Am Surg Patient/Injury factors for LS *Mixed population (lower definitive vascular repair in or Amp and upper extremities) peripheral vascular injuries? Ademoglu, Y.; Ada, S.; Should the amputations of the 2000 Foot Ankle Int Patient/Injury factors for LS <10 pts Kaplan, I. great toe be replanted? or Amp Stewart, M. P.; Shotgun wounds of the limbs 1993 Injury Patient/Injury factors for LS *mixed-upper & lower Kinninmonth, A. or Amp extremity*

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Keeling, J. J.; Gwinn, D. E.; Short-term outcomes of severe 2008 J Bone Joint Surg Am Environmental factors for LS No controlled comparison; Tintle, S. M.; Andersen, R. open wartime tibial fractures or Amp No relevant RFs C.; McGuigan, F. X. treated with ring external fixation Rau, B.; Bonvin, F.; de Bie, Short-term effect of 2007 Prosthet Orthot Int Environmental factors for LS Mixed Etiology R. physiotherapy rehabilitation on or Amp functional performance of lower limb amputees Toepfer, A.; Harrasser, N.; Short- to long-term follow-up of 2016 BMC Musculoskelet Patient/Injury factors for LS Incorrect pts population Petzschner, I.; Pohlig, F.; total femoral replacement in Disord or Amp Lenze, U.; Gerdesmeyer, non-oncologic patients L.; Pforringer, D.; Toepfer, M.; Beirer, M.; Cronlein, M.; von Eisenhart-Rothe, R.; Muhlhofer, H. Stuebing, E.; Lieberman, Shank vessel injuries: the 2012 Eur J Trauma Emerg Patient/Injury factors for LS Review H.; Vu, T.; Mazzini, F. N.; forgotten vascular injuries Surg or Amp De Gregorio, L.; Gigena, A.; Iglesias, E.; Gonzalo, R.; Perez-Alonso, A. J.; Asensio, J. A. Rowe, V. L.; Salim, A.; Shank vessel injuries 2002 Surg Clin North Am Systematic Reviews review Lipham, J.; Asensio, J. A. McNamara, M. G.; Severe open fractures of the 1994 J Orthop Trauma Immediate amputation Amputation/Salvage as Heckman, J. D.; Corley, F. lower extremity: a retrospective factors outcome G. evaluation of the Mangled Extremity Severity Score (MESS) Kurtoglu, M.; Yanar, H.; Serious lower extremity venous 2007 Am Surg Environmental factors for LS No relevant RFs Taviloglu, K.; Sivrikoz, E.; injury management with or Amp Plevin, R.; Aksoy, M. ligation: prospective overview of 63 patients Giannoudis, P. V.; Segmental tibial fractures: an 2003 Injury Immediate amputation No controlled comparison Hinsche, A. F.; Cohen, A.; assessment of procedures in 27 factors Macdonald, D. A.; cases Matthews, S. J.; Smith, R. M.

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Woll, T. S.; Duwelius, P. J. The segmental tibial fracture 1992 Clin Orthop Relat Res Patient/Injury factors for LS Mixed etiology or Amp Section 2: Limb Salvage and 2017 J Orthop Trauma Immediate amputation review Amputation After Major Lower factors Limb Trauma Dupaix, J. P.; Wilding, C. S. Second Place: Dismounted 2018 Current Orthopaedic Immediate amputation very low quality R.; Tubb, C. C. C.; Oh, C. J. complex blast injuries: Patterns Practice factors; Patient/Injury S.; Ryan, L. P. M. of remaining limb injuries in factors for LS or Amp patients with single-limb lower extremity amputations Rajasekaran, S.; Naresh A score for predicting salvage 2006 J Bone Joint Surg Br Immediate amputation Amp/Sal as outcome Babu, J.; Dheenadhayalan, and outcome in Gustilo type-IIIA factors J.; Shetty, A. P.; and type-IIIB open tibial Sundararajan, S. R.; fractures Kumar, M.; Rajasabapathy, S. Hallaj Karladani, A.; Salvaged limbs after tibial shaft 2001 Journal of Trauma - Patient/Injury factors for LS No controlled comparisons Granhed, H.; Fogdestam, fractures with extensive soft- Injury, Infection and or Amp I.; Styf, J. tissue injury: A biopsychosocial Critical Care function analysis Kumar, M. K.; Badole, C.; Salvage versus amputation: 2007 Indian J Orthop Immediate amputation Amp/Sal as outcome Patond, K. Utility of mangled extremity factors severity score in severely injured lower limbs Rohde, C.; Ascherman, J. Salvage Reconstruction of Lower 2009 Techniques in Review; No usable data A. Extremity Defects with Muscle Orthopaedics Flaps: Versatility, Techniques, and Limitations Kind, G. M.; Dickinson, J. Salvage of the severely 1997 Surg Technol Int Immediate amputation case series; wrong age A.; Buncke, G. M.; Buntic, traumatized lower extremity factors range R. F.; Chin, B.; Buncke, H. J., Jr. Sanders, R.; Pappas, J.; The salvage of open grade IIIB 1992 J Orthop Trauma Immediate amputation not enough subjects per Mast, J.; Helfet, D. ankle and talus fractures factors group (n=11) Dagum, A. B.; Best, A. K.; Salvage after severe lower- 1999 Plast Reconstr Surg Patient/Injury factors for LS prospective univariate; Schemitsch, E. H.; extremity trauma: are the or Amp very low quality outcomes worth the means? 114

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Humphrey, P. W.; Nichols, Rural vascular trauma: a twenty- 1994 Ann Vasc Surg Patient/Injury factors for LS *mixed-upper & lower W. K.; Silver, D. year review or Amp extremity* Sayed, L.; Kelemen, N.; The Role of the Very Long 2013 Plast Reconstr Surg Systematic Reviews systematic review Williams, S.; Offer, G. J. Posterior Tibial Artery Flap Glob Open following Severe Lower Limb Trauma: Case Series and Literature Review Giannoudis, P. V.; The role of plating in the 2009 Int Orthop Systematic Reviews Systematic Review Papakostidis, C.; Kouvidis, operative treatment of severe G.; Kanakaris, N. K. open tibial fractures: a systematic review Kasabian, A. K.; Colen, S. The role of microvascular free 1991 J Trauma Immediate amputation case series R.; Shaw, W. W.; Pachter, flaps in salvaging below-knee factors H. L. amputation stumps: a review of 22 cases Attinger, C. E.; Ducic, I.; The role of intrinsic muscle flaps 2002 Plast Reconstr Surg mixed etiology; Cooper, P.; Zelen, C. M. of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients Moda, S. K.; Kalra, G. S.; The role of early flap coverage 1994 Injury Patient/Injury factors for LS Mixed etiology Gupta, R. S.; Maggu, N. K.; in the management of open or Amp Gupta, R. K.; Kalra, M. K. fractures of both bones of the leg Kendall, R. W.; Taylor, D. The role of arteriography in 1993 J Trauma Patient/Injury factors for LS No controlled comparison C.; Salvian, A. J.; O'Brien, assessing vascular injuries or Amp P. J. associated with dislocations of the knee Hohmann, E.; Birkholtz, F.; The "Road to Union" protocol 2017 Injury Patient/Injury factors for LS No usable data Glatt, V.; Tetsworth, K. for the reconstruction of or Amp; Environmental isolated complex high-energy factors for LS or Amp tibial trauma

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Harwood, P. J.; The risk of local infective 2006 J Orthop Trauma Environmental factors for LS prospective univariate; Giannoudis, P. V.; Probst, complications after damage or Amp very low quality; no RF of C.; Krettek, C.; Pape, H. C. control procedures for femoral interest shaft fracture Henry, P.; Wasserstein, D.; Risk factors for reoperation and 2015 J Orthop Trauma Patient/Injury factors for LS unclear etiology; Paterson, M.; Kreder, H.; mortality after the operative or Amp Jenkinson, R. treatment of tibial plateau fractures in Ontario, 1996-2009 Helgeson, M. D.; Potter, B. Risk factors for and results of 2010 Orthopedics Patient/Injury factors for LS mixed extremity K.; Burns, T. C.; Hayda, R. late or delayed amputation or Amp A.; Gajewski, D. A. following combat-related extremity injuries Al Wahbi, A.; Aldakhil, S.; Risk factors for amputation in 2016 Vasc Health Risk Immediate amputation mixed extremity; very low Al Turki, S.; El Kayali, A.; extremity vascular injuries in Manag factors quality Al Kohlani, H.; Al Saudi Arabia Showmer, A. Rodriguez, C. J.; Weintrob, Risk factors associated with 2014 Surg Infect (Larchmt) Patient/Injury factors for LS mixed extremity A. C.; Shah, J.; Malone, D.; invasive fungal infections in or Amp Dunne, J. R.; Weisbrod, A. combat trauma B.; Lloyd, B. A.; Warkentien, T. E.; Murray, C. K.; Wilkins, K.; Shaikh, F.; Carson, M. L.; Aggarwal, D.; Tribble, D. R. Ramdass, M. J.; Muddeen, Risk factors associated with 2018 Injury Immediate amputation very low quality A.; Harnarayan, P.; amputation in civilian popliteal factors Spence, R.; Milne, D. artery trauma Bates, B. E.; Xie, D.; Revisiting risks associated with 2012 J Rehabil Res Dev Immediate amputation wrong age range; mixed Kurichi, J. E.; Cowper mortality following initial factors etiology; Ripley, D.; Kwong, P. L.; transtibial or transfemoral Stineman, M. G. amputation Giannoudis, P. V.; A review of the management of 2006 J Bone Joint Surg Br Systematic Reviews Systematic review; Papakostidis, C.; Roberts, open fractures of the tibia and C. femur

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Robbins, C. B.; Vreeman, A review of the long-term 2009 Mil Med Systematic Reviews *systematic review; D. J.; Sothmann, M. S.; health outcomes associated references reviewed* Wilson, S. L.; Oldridge, N. with war-related amputation B. Siev-Ner, I.; Heim, M.; A review of the aetiological 2006 Disability and Immediate amputation Wrong population Warshavski, M.; Daich, A.; factors and results of trans- Rehabilitation factors; Patient/Injury Tamir, E.; Dudkiewicz, I. ankle (Syme) disarticulations factors for LS or Amp Olesen, U. K.; Juul, R.; A review of forty five open tibial 2015 Int Orthop Patient/Injury factors for LS Mixed etiology; no Bonde, C. T.; Moser, C.; fractures covered with free or Amp controlled comparison McNally, M.; Jensen, L. T.; flaps. Analysis of complications, Elberg, J. J.; Eckardt, H. microbiology and prognostic factors Orr, J.; Kirk, K. L.; Antunez, Reverse sural artery flap for 2010 Foot Ankle Int Immediate amputation 10 subjects; V.; Ficke, J. reconstruction of blast injuries factors of the foot and ankle Moini, M.; Takyar, M. A.; Revascularisation later than 24h 2007 Injury Patient/Injury factors for LS Too few pts Rasouli, M. R. after popliteal artery trauma: is or Amp it worthwhile? Burger, H.; Marincek, C. Return to work after lower limb 2007 Disabil Rehabil Systematic Reviews *systematic review; amputation references reviewed*

Owens, J. G.; Blair, J. A.; Return to running and sports 2011 J Trauma No Controlled Comparison Patzkowski, J. C.; Blanck, participation after limb salvage R. V.; Hsu, J. R. Barrow, A. E.; Sheean, A. Return to duty following 2017 Injury Patient/Injury factors for LS mixed etiology J.; Burns, T. C. combat-related multi- or Amp ligamentous knee injury Sheean, A. J.; Krueger, C. Return to duty and disability 2014 J Orthop Trauma Patient/Injury factors for LS no controlled comparison A.; Hsu, J. R. after combat-related hindfoot or Amp injury Cross, J. D.; Stinner, D. J.; Return to duty after type III 2012 J Orthop Trauma Patient/Injury factors for LS retrospective, univariate - Burns, T. C.; Wenke, J. C.; open tibia fracture or Amp very low quality Hsu, J. R. Salamon, T.; Lerner, A.; Retrospective analysis of case 2016 Injury Immediate amputation 10 subjects; Rothem, D.; Altshuler, A.; series of patients with vascular factors; Patient/Injury Karmeli, R.; Solomonov, war injury treated in a district factors for LS or Amp E.; Biswas, S. hospital

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Patterson, B. M.; Routt, Retrograde nailing of femoral 1995 J Trauma Patient/Injury factors for LS No comparisons M. L., Jr.; Benirschke, S. K.; shaft fractures or Amp Hansen, S. T., Jr. Zamir, G.; Berlatzky, Y.; Results of reconstruction in 1998 J Vasc Surg Immediate amputation Mixed etiology; Rivkind, A.; Anner, H.; major pelvic and extremity factors; Patient/Injury Wolf, Y. G. venous injuries factors for LS or Amp Smith, E.; Ryall, N. Residual limb osteomyelitis: a 2009 Disabil Rehabil Immediate amputation Wrong population case series from a national factors; Patient/Injury prosthetic centre factors for LS or Amp Guo, Q. F.; Xu, Z. H. Rescue and treatment of 2005 Chin J Traumatol Immediate amputation Case series; No controlled severely injured lower factors; Patient/Injury comparison extremities factors for LS or Amp Percival, T. J.; Rasmussen, Reperfusion strategies in the 2012 Br J Surg Systematic Reviews review T. E. management of extremity vascular injury with ischaemia Tintle, S. M.; Shawen, S. Reoperation after combat- 2014 J Orthop Trauma Patient/Injury factors for LS No RF of interest; B.; Forsberg, J. A.; related major lower extremity or Amp Gajewski, D. A.; Keeling, J. amputations J.; Andersen, R. C.; Potter, B. K. Ege, T.; Unlu, A.; Tas, H.; Reliability of the mangled 2015 Indian J Orthop Patient/Injury factors for LS *mixed-upper & lower Bek, D.; Turkan, S.; extremity severity score in or Amp extremity* Cetinkaya, A. combat-related upper and lower extremity injuries Sears, E. D.; Davis, M. M.; Relationship between timing of 2012 Plast Reconstr Surg Patient/Injury factors for LS Amputation/Salvage as Chung, K. C. emergency procedures and limb or Amp; Environmental Outcome amputation in patients with factors for LS or Amp open tibia fracture in the United States, 2003 to 2009 Wezenberg, D.; van der Relation between aerobic 2013 Arch Phys Med Immediate amputation mixed etiology Woude, L. H.; Faber, W. capacity and walking ability in Rehabil factors X.; de Haan, A.; Houdijk, older adults with a lower-limb H. amputation Doi, K.; Sakai, K.; Ihara, K.; Reinnervated free muscle 1993 Plast Reconstr Surg mixed trauma/mixed Abe, Y.; Kawai, S.; transplantation for extremity etiology Kurafuji, Y. reconstruction

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Hoyt, B. W.; Pavey, G. J.; Rehabilitation of Lower 2015 Current Trauma Environmental factors for LS No Controlled Pasquina, P. F.; Potter, B. Extremity Trauma: a Review of Reports or Amp Comparison; No usable K. Principles and Military data Perspective on Future Directions Arangio, G. A.; Lehr, S.; Reemployment of patients with 1997 J Trauma Patient/Injury factors for LS No RF of interest Reed, J. F., 3rd surgical salvage of open, high- or Amp energy tibial fractures: an outcome study Gross, D. P.; Battie, M. C. Recovery expectations predict 2010 J Spinal Disord Tech Environmental factors for LS mixed extremity; mixed recovery in workers with back or Amp etiology pain but not other musculoskeletal conditions Tomaino, M.; Bowen, V. Reconstructive surgery for 1995 Can J Surg Immediate amputation review lower limb salvage factors; Patient/Injury factors for LS or Amp Kombate, N. K.; Walla, A.; Reconstruction of traumatic 2017 J Orthop Patient/Injury factors for LS Mixed population; case Ayouba, G.; Bakriga, B. bone loss using the induced or Amp series; M.; Dellanh, Y. Y.; Abalo, membrane technique: A. G.; Dossim, A. M. preliminary results about 11 cases Lovric, Z.; Wertheimer, B.; Reconstruction of the popliteal 1994 Unfallchirurg Patient/Injury factors for LS Case series; no controlled Candrlic, K.; Lehner, V.; artery after war injury or Amp comparison Rubin, O. Kucan, J. O.; Bash, D. Reconstruction of the burned 1992 Clinics in Plastic Immediate amputation review foot Surgery factors; Patient/Injury factors for LS or Amp Goldberg, D. P.; Kucan, J. Reconstruction of the burned 2000 Clin Plast Surg Patient/Injury factors for LS Review O.; Bash, D. foot or Amp Fakri, R. M.; Al Ani, A. M.; Reconstruction of nonunion 2012 J Orthop Trauma Patient/Injury factors for LS Retrospective Univariate; Rose, A. M.; Alras, M. S.; tibial fractures in war-wounded or Amp very low quality Daumas, L.; Baron, E.; Iraqi civilians, 2006-2008: better Khaddaj, S.; Herard, P. late than never Lovric, Z.; Lehner, V.; Reconstruction of major arteries 1996 J Cardiovasc Surg Patient/Injury factors for LS prospective univariate; Kosic-Lovric, L.; of lower extremities after war (Torino) or Amp very low quality Wertheimer, B. injuries. Long-term follow up

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Ulusal, B. G.; Lin, Y. T.; Reconstruction of foot defects 2005 Microsurgery Patient/Injury factors for LS *mixed trauma Ulusal, A. E.; Lin, C. H.; with free lateral arm or Amp Yen, J. T. fasciocutaneous flaps: analysis of fifty patients Lenoble, E.; Lewertowski, Reconstruction of compound 1995 J Trauma 12 patients J. M.; Goutallier, D. tibial and soft tissue loss using a traction histogenesis technique Anderson, C. D.; Stewart, Recent advances in lower- 2007 Current Opinion in Immediate amputation review J. D.; Unger, D. V. extremity amputations Orthopaedics factors; Patient/Injury factors for LS or Amp Fergason, J.; Keeling, J. J.; Recent advances in lower 2010 Foot Ankle Clin Systematic Reviews review Bluman, E. M. extremity amputations and prosthetics for the combat injured patient Halim, A. S.; Imran, Y. Recalcitrant post-traumatic 2006 Med J Malaysia Immediate amputation 8 patients chronic osteomyelitis/infected factors; Patient/Injury non-union of the tibia following factors for LS or Amp open grade-ill fractures: treatment with vascularized osteocutaneous fibular graft Keating, J. F.; Blachut, P. Reamed nailing of open tibial 1996 J Orthop Trauma Environmental factors for LS prospective univariate; no A.; O'Brien, P. J.; Meek, R. fractures: does the antibiotic or Amp RF of interest; N.; Broekhuyse, H. bead pouch reduce the deep infection rate? Keating, J. F.; Blachut, P. Reamed nailing of Gustilo grade- 2000 J Bone Joint Surg Br Patient/Injury factors for LS prospective univariate; A.; O'Brien, P. J.; Court- IIIB tibial fractures or Amp very low quality Brown, C. M. Keating, J. F.; O'Brien, P. Reamed interlocking 1997 Clin Orthop Relat Res Patient/Injury factors for LS too few pts; I.; Blachut, P. A.; Meek, R. intramedullary nailing of open or Amp N.; Broekhuyse, H. M. fractures of the tibia Pincus, D.; Veljkovic, A.; Rate of and Risk Factors for 2017 J Orthop Trauma Patient/Injury factors for LS unclear etiology; Zochowski, T.; Mahomed, Intermediate-Term Reoperation or Amp N.; Ogilivie-Harris, D.; After Ankle Fracture Fixation: A Wasserstein, D. Population-Based Cohort Study Weber, D. J.; Shoham, D. Racial odds for amputation ratio 2011 J Trauma Immediate amputation Amputation/Salvage as A.; Luke, A.; Reed, R. L., in traumatic lower extremity factors; Environmental outcome 2nd; Luchette, F. A. fractures factors for LS or Amp 120

Kuralay, E.; Demirkilic, U.; A quantitative approach to 2002 J Vasc Surg Patient/Injury factors for LS Doesn't address question Ozal, E.; Oz, B. S.; Cingoz, lower extremity vein repair or Amp of interest; Mixed Etiology F.; Gunay, C.; Yildirim, V.; Arslan, M.; Tatar, H. Pasquina, P. F.; Tsao, J. Quality of medical care provided 2008 J Rehabil Res Dev Environmental factors for LS No Controlled Comparison W.; Collins, D. M.; Chan, B. to service members with or Amp L.; Charrow, A.; combat-related limb Karmarkar, A. M.; Cooper, amputations: report of patient R. A. satisfaction Nwachukwu, B. U.; The Quality of Cost-Utility 2015 Orthopedics Systematic Reviews References Reviewed Schairer, W. W.; O'Dea, E.; Analyses in Orthopedic Trauma McCormick, F.; Lane, J. M. Shauver, M. S.; Aravind, A qualitative study of recovery 2011 Ann Plast Surg Environmental factors for LS No Controlled M. S.; Chung, K. C. from type III-B and III-C tibial or Amp Comparison; No fractures comparison group Ali, S.; Abu Osman, N. A.; Qualitative study of prosthetic 2012 Arch Phys Med Environmental factors for LS No Controlled Naqshbandi, M. M.; suspension systems on Rehabil or Amp Comparison; no relevant Eshraghi, A.; Kamyab, M.; transtibial amputees' RFs Gholizadeh, H. satisfaction and perceived problems with their prosthetic devices Quon, D. L.; Dudek, N. L.; A qualitative study of factors 2011 J Bone Joint Surg Am Immediate amputation 8 patients Marks, M.; Boutet, M.; influencing the decision to have factors Varpio, L. an elective amputation Aravind, M.; Shauver, M. A qualitative analysis of the 2010 Plast Reconstr Surg Patient/Injury factors for LS no usable data J.; Chung, K. C. decision-making process for or Amp patients with severe lower leg trauma Mousavi, B.; Masoumi, The psychological morbidity in 2017 Medical Journal Patient/Injury factors for LS No controlled comparison M.; Soroush, M.; Shahriar, the long term after war related Armed Forces India or Amp S.; Firoozabadi, A. bilateral lower limb amputation Sahu, A.; Sagar, R.; Sarkar, Psychological effects of 2016 Ind Psychiatry J Systematic Reviews *systematic review; S.; Sagar, S. amputation: A review of studies references reviewed* from India

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Stranix, J. T.; Borab, Z. M.; Proximal versus Distal Recipient 2018 Journal of Systematic Reviews Doesn't address question Rifkin, W. J.; Jacoby, A.; Vessels in Lower Extremity Reconstructive of interest; Lee, Z. H.; Anzai, L.; Reconstruction: A Retrospective Microsurgery Ceradini, D. J.; Thanik, V.; Series and Systematic Review Saadeh, P. B.; Levine, J. P. Ebied, A. M.; Elseedy, A. I.; A protocol for staged 2017 J Orthop Traumatol Patient/Injury factors for LS Unclear trauma; no Gamal, O. arthroplasty to salvage infected or Amp controlled comparison nonunion of hip fractures Ward, R. S.; Hayes-Lundy, Prosthetic use in patients with 1990 J Burn Care Rehabil Patient/Injury factors for LS Mixed etiology; C.; Schnebly, W. A.; Saffle, burns and associated limb or Amp J. R. amputations Smith, D. G.; Horn, P.; Prosthetic history, prosthetic 1995 J Trauma Environmental factors for LS no comparison group Malchow, D.; Boone, D. charges, and functional or Amp A.; Reiber, G. E.; Hansen, outcome of the isolated, S. T., Jr. traumatic below-knee amputee Burger, H.; Marincek, C.; Prosthetic device provision to 2004 Arch Phys Med Environmental factors for LS No controlled comparison; Jaeger, R. J. landmine survivors in Bosnia Rehabil or Amp No relevant RFs and Herzegovina: outcomes in 3 ethnic groups Raichle, K. A.; Hanley, M. Prosthesis use in persons with 2008 J Rehabil Res Dev Environmental factors for LS mixed etiology A.; Molton, I.; Kadel, N. J.; lower- and upper-limb or Amp Campbell, K.; Phelps, E.; amputation Ehde, D.; Smith, D. G. Delauche, M. C.; A Prospective Study of the 2013 PLoS Curr Patient/Injury factors for LS Prospective univariate; Blackwell, N.; Le Perff, H.; Outcome of Patients with Limb or Amp very low quality Khallaf, N.; Muller, J.; Trauma following the Haitian Callens, S.; Allafort Earthquake in 2010 at One- and Duverger, T. Two- Year (The SuTra2 Study) Bosse, M. J.; MacKenzie, A prospective evaluation of the 2001 J Bone Joint Surg Am Immediate amputation SENS/SPEC outcome E. J.; Kellam, J. F.; Burgess, clinical utility of the lower- factors measure; Amp/Sal as A. R.; Webb, L. X.; extremity injury-severity scores outcome Swiontkowski, M. F.; Sanders, R. W.; Jones, A. L.; McAndrew, M. P.; Patterson, B. M.; McCarthy, M. L.; Cyril, J. K.

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Rerkasem, K.; Arworn, S.; Prognostic factors of leg 2006 Int J Low Extrem Systematic Reviews *systematic review; Thepmalai, K. amputation in patients with Wounds references reviewed* vascular injury: a systematic review Maricevic, A.; Erceg, M.; Primary wound closure in war 1997 Int Orthop Patient/Injury factors for LS Mixed etiology; no Gekic, K. amputations of the limbs or Amp controlled comparisons Nikolic, D.; Jovanovic, Z.; Primary surgical treatment of 2000 Injury Patient/Injury factors for LS No controlled comparison Vulovic, R.; Mladenovic, war injuries of the foot or Amp M. Nikolic, D.; Jovanovic, Z.; Primary surgical treatment of 1999 Injury Patient/Injury factors for LS *mixed-upper & lower Popovic, Z.; Vulovic, R.; war injuries of major joints of or Amp extremity* Mladenovic, M. the limbs Schiro, G. R.; Sessa, S.; Primary amputation vs limb 2015 BMC Musculoskelet Systematic Reviews *systematic review; Piccioli, A.; Maccauro, G. salvage in mangled extremity: a Disord references reviewed* systematic review of the current scoring system Abeyasinghe, N. L.; de The prevalence of symptoms of 2012 Psychol Health Med Patient/Injury factors for LS mixed population Zoysa, P.; Bandara, K. M.; Post-Traumatic Stress Disorder or Amp Bartholameuz, N. A.; among soldiers with amputation Bandara, J. M. of a limb or spinal injury: a report from a rehabilitation centre in Sri Lanka Struyf, P. A.; van Heugten, The prevalence of osteoarthritis 2009 Arch Phys Med Patient/Injury factors for LS Prospective univariate; C. M.; Hitters, M. W.; of the intact hip and knee Rehabil or Amp very low quality Smeets, R. J. among traumatic leg amputees Stinner, D. J.; Burns, T. C.; Prevalence of late amputations 2010 Mil Med Immediate amputation no RF of interest; Kirk, K. L.; Scoville, C. R.; during the current conflicts in factors; Patient/Injury Ficke, J. R.; Hsu, J. R. Afghanistan and Iraq factors for LS or Amp Papakostidis, C.; Prevalence of complications of 2011 Injury Systematic Reviews *systematic review; Kanakaris, N. K.; Pretel, J.; open tibial shaft fractures references reviewed* Faour, O.; Morell, D. J.; stratified as per the Gustilo- Giannoudis, P. V. Anderson classification Jeffers, R. F.; Tan, H. B.; Prevalence and patterns of foot 2004 J Orthop Trauma Immediate amputation Doesn't address question Nicolopoulos, C.; Kamath, injuries following motorcycle factors of interest; case series R.; Giannoudis, P. V. trauma

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Raichle, K. A.; Osborne, T. Preoperative state anxiety, 2015 Clin J Pain Immediate amputation mixed etiology L.; Jensen, M. P.; Ehde, D. acute postoperative pain, and factors M.; Smith, D. G.; analgesic use in persons Robinson, L. R. undergoing lower limb amputation Wise, E. S.; McMaster, W. Preoperative Predictors of 30- 2016 Ann Vasc Surg Patient/Injury factors for LS mixed etiology G., Jr.; Williamson, K.; Day Mortality and Prolonged or Amp Wergin, J. E.; Hocking, K. Length of Stay after Above-Knee M.; Brophy, C. M. Amputation Song, W.; Zhou, D.; Dong, Predictors of secondary 2017 Medicine (Baltimore) Immediate amputation very low quality J. amputation in patients with factors; Patient/Injury grade IIIC lower limb injuries: A factors for LS or Amp retrospective analysis of 35 patients Song, W.; Zhou, D.; Dong, Predictors of secondary 2017 Medicine (United Immediate amputation duplicate of AAOS 279; J. amputation in patients with States) factors grade IIIC lower limb injuries Yavuz, C.; Demirtas, S.; The predictors of poor 2013 Eur Rev Med Immediate amputation mixed etiology; Caliskan, A.; Ertas, F.; outcomes in patients with Pharmacol Sci factors Kaya, H.; Aydin, M.; Benli, femoral artery injuries E. D.; Celik, Y.; Eren, M. N. Pape, H. C.; Probst, C.; Predictors of late clinical 2010 J Trauma Patient/Injury factors for LS mixed extremity Lohse, R.; Zelle, B. A.; outcome following orthopedic or Amp Panzica, M.; Stalp, M.; injuries after multiple trauma Steel, J. L.; Duhme, H. M.; Pfeifer, R.; Krettek, C.; Sittaro, N. A. Fainzilber, G.; Roy- Predictors of amputation for 1995 Am J Surg Immediate amputation very low quality Shapira, A.; Wall, M. J., Jr.; popliteal artery injuries factors Mattox, K. L. Bolandparvaz, S.; Ghaffari, Predictive Value of Biochemical 2013 Bull Emerg Trauma Patient/Injury factors for LS mixed extremity B.; Mousavi, S. M.; Markers for Extremity Vascular or Amp Paydar, S.; Abbasi, H. R. Trauma Outcome Karami, M.; Sadat, M. M.; Predictive validity testing of 2004 Archives of Iranian Patient/Injury factors for LS Amp/Sal as outcome Tavakkoli, H.; Taghavi, M.; severely injured limb scoring Medicine or Amp Golbakhsh, M. R. systems

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Robertson, P. A. Prediction of amputation after 1991 J Bone Joint Surg Br Immediate amputation No Controlled Comparison severe lower limb trauma factors; Patient/Injury factors for LS or Amp Sears, J. M.; Blanar, L.; Predicting work-related 2013 J Occup Rehabil Immediate amputation mixed extremity Bowman, S. M.; Adams, disability and medical cost factors D.; Silverstein, B. A. outcomes: estimating injury severity scores from workers' compensation data Sansam, K.; Neumann, V.; Predicting walking ability 2009 J Rehabil Med Systematic Reviews References Reviewed O'Connor, R.; Bhakta, B. following lower limb amputation: a systematic review of the literature Brown, K. V.; Ramasamy, Predicting the need for early 2009 J Trauma Immediate amputation Amp/Sal as outcome A.; McLeod, J.; Stapley, S.; amputation in ballistic mangled factors Clasper, J. C. extremity injuries Madhuchandra, P.; Rafi, Predictability of salvage and 2015 Injury Immediate amputation Amp/Sal as outcome M.; Devadoss, S.; outcome of Gustilo and factors Devadoss, A. Anderson type-IIIA and type-IIIB open tibial fractures using Ganga Hospital Scoring system Fochtmann, A.; Mittlbock, Potential prognostic factors 2014 J Trauma Acute Care Immediate amputation very low quality M.; Binder, H.; predicting secondary Surg factors Kottstorfer, J.; Hajdu, S. amputation in third-degree open lower limb fractures Agel, J.; Rockwood, T.; Potential predictive ability of 2014 J Orthop Trauma Immediate amputation Amputation/Salvage as Barber, R.; Marsh, J. L. the orthopaedic trauma factors outcome association open fracture classification Kienast, B.; Kiene, J.; Gille, Posttraumatic severe infection 2010 Eur J Med Res Patient/Injury factors for LS Unclear trauma; no J.; Thietje, R.; Gerlach, U.; of the ankle joint - long term or Amp comparisons Schulz, A. P. results of the treatment with resection arthrodesis in 133 cases Davidovic, L.; Lotina, S.; Post-traumatic AV fistulas and 1997 J Cardiovasc Surg Patient/Injury factors for LS Mixed etiology; mixed Vojnovic, B.; Kostic, D.; pseudoaneurysms (Torino) or Amp population; Cinara, I.; Cvetkovic, S.; Saponjski, J.; Neskovic, V.

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Koski, A.; Kuokkanen, H.; Postoperative wound 2005 Scand J Surg Patient/Injury factors for LS Mixed etiology; Tukiainen, E. complications after internal or Amp fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures Simpson, J. M.; Ebraheim, Posterolateral bone graft of the 1990 Clin Orthop Relat Res Patient/Injury factors for LS Case series; no controlled N. A.; An, H. S.; Jackson, tibia or Amp comparison W. T. Gallagher, P.; MacLachlan, Positive meaning in amputation 2000 Prosthet Orthot Int Environmental factors for LS Mixed Etiology M. and thoughts about the or Amp amputated limb Grego, F.; Antonello, M.; Popliteal-to-distal bypass for 2004 Ann Vasc Surg Patient/Injury factors for LS Mixed etiology Stramana, R.; Deriu, G. P.; limb salvage or Amp Lepidi, S. Fairhurst, P. G.; Wyss, T. Popliteal vessel trauma: Surgical 2018 Knee Immediate amputation Wrong population R.; Weiss, S.; Becker, D.; approaches and the vessel-first factors Schmidli, J.; Makaloski, V. strategy Peck, J. J.; Eastman, A. B.; Popliteal vascular trauma. A 1990 Arch Surg Immediate amputation not best available Bergan, J. J.; Sedwitz, M. community experience factors M.; Hoyt, D. B.; McReynolds, D. G. Simmons, J. D.; Gunter, J. Popliteal artery injuries in an 2011 Am Surg Immediate amputation unclear etiology; no W., 3rd; Schmieg, R. E., Jr.; urban trauma center with a factors regression Manley, J. D.; Rushton, F. rural catchment area: do delays W., Jr.; Porter, J. M.; in definitive treatment affect Mitchell, M. E. amputation? Subasi, M.; Cakir, O.; Popliteal artery injuries 2001 Acta Orthop Belg Patient/Injury factors for LS No controlled comparison Kesemenli, C.; Arslan, H.; associated with fractures and or Amp Necmioglu, S.; Eren, N. dislocations about the knee Lescalie, F.; Reigner, B. Popliteal arterial traumas: 1994 J Cardiovasc Surg Patient/Injury factors for LS Mixed etiology; no prognosis factors: multi-center (Torino) or Amp controlled comparison prospective study apropos of 40 cases Bryan, T.; Merritt, P.; Popliteal arterial injuries 1991 Orthop Rev Patient/Injury factors for LS Mixed etiology Hack, B. associated with fractures or or Amp

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Pierce, R. O., Jr.; Kernek, The plight of the traumatic 1993 Orthopedics Patient/Injury factors for LS No controlled comparisons C. B.; Ambrose, T. A., 2nd amputee or Amp Wilken, J. M.; Roy, C. W.; Physical Performance 2018 J Orthop Trauma Environmental factors for LS mixed etiology Shaffer, S. W.; Patzkowski, Limitations After Severe Lower or Amp J. C.; Blanck, R. V.; Owens, Extremity Trauma in Military J. G.; Hsu, J. R. Service Members Christensen, J.; Ipsen, T.; Physical and social factors 2016 Disabil Rehabil Systematic Reviews References Reviewed Doherty, P.; Langberg, H. determining quality of life for veterans with lower-limb amputation(s): a systematic review Dillingham, T. R.; Persian Gulf War amputees: 1994 Mil Med Patient/Injury factors for LS mixed population Braverman, S. E.; injuries and rehabilitative needs or Amp Belandres, P. V. Gwinn, D. E.; Keeling, J.; Perioperative differences 2008 Foot Ankle Int Environmental factors for LS No Controlled Comparison Froehner, J. W.; between bone bridging and or Amp McGuigan, F. X.; non-bone bridging transtibial Andersen, R. amputations for wartime lower extremity trauma Degiannis, E.; Levy, R. D.; Penetrating injuries of the 1995 Br J Surg Immediate amputation No Controlled Comparison Velmahos, G. C.; Potokar, femoral artery factors; Patient/Injury T.; Saadia, R. factors for LS or Amp Woodward, E. B.; Clouse, Penetrating femoropopliteal 2008 J Vasc Surg Immediate amputation No Controlled Comparison W. D.; Eliason, J. L.; Peck, injury during modern warfare: factors M. A.; Bowser, A. N.; Cox, experience of the Balad M. W.; Jones, W. T.; Vascular Registry Rasmussen, T. E. Rayamajhi, S.; Murugan, Penetrating femoral artery 2018 Eur J Trauma Emerg Patient/Injury factors for LS No controlled comparison N.; Nicol, A.; Edu, S.; injuries: an urban trauma centre Surg or Amp Klopper, J.; Naidoo, N.; experience Navsaria, P.

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Janjua, S. A.; Sarwar, S. U. Pedicled gastrocnemius muscle 2001 Journal of the Patient/Injury factors for LS no controlled analysis; R. flap in the management of College of Physicians or Amp case series; complex wounds around the and Surgeons knee joint Pakistan Banskota, B.; Shrestha, S.; Patterns of Orthopaedic Injuries 2016 J Nepal Health Res Immediate amputation Mixed population Chaudhary, R. K.; among Motorbike Accident Counc factors Rajbhandari, T.; Rijal, S.; Admissions Presenting to a Shrestha, B. K.; Banskota, Tertiary Care Hospital in A. K. Kathmandu Moini, M.; Rasouli, M. R.; Patterns of extremity traumas 2009 Chin J Traumatol Immediate amputation *Mixed population and Khaji, A.; Farshidfar, F.; leading to amputation in Iran: factors; Patient/Injury etiology Heidari, P. results of Iranian National factors for LS or Amp Trauma Project Fairbanks, G. A.; Murphy, Patterns and implications of 2004 Ann Plast Surg Patient/Injury factors for LS Mixed etiology; unclear R. X., Jr.; Wasser, T. E.; lower extremity injuries in a or Amp trauma; no controlled Morrissey, W. M. community level I trauma comparison center Gebreslassie, B.; Patterns and Causes of 2018 Ethiop J Health Sci Patient/Injury factors for LS Mixed etiology Gebreselassie, K.; Esayas, Amputation in Ayder Referral or Amp R. Hospital, Mekelle, Ethiopia: A Three-Year Experience Ogeng'o, J. A.; Obimbo, Pattern of limb amputation in a 2009 Int Orthop Patient/Injury factors for LS Mixed etiology M. M.; King'ori, J. Kenyan rural hospital or Amp Hull, J. B.; Bowyer, G. W.; Pattern of injury in those dying 1994 Br J Surg Immediate amputation Mixed population Cooper, G. J.; Crane, J. from traumatic amputation factors caused by bomb blast Patel, H. D.; Dryden, S.; Pattern and mechanism of 2012 J Trauma Acute Care Immediate amputation No Controlled Comparison Gupta, A.; Ang, S. C. traumatic limb amputations Surg factors after explosive blast: experience from the 07/07/05 London terrorist bombings Segrt, B. Particularities of the therapeutic 2014 Vojnosanit Pregl Environmental factors for LS No Controlled Comparison procedures and success in or Amp treatment of combat-related lower extremities injuries

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Seekamp, A.; Regel, G.; Parameters of multiple organ 1999 Injury Patient/Injury factors for LS no controlled comparisons Hildebrand, F.; Sander, J.; dysfunction fail to predict or Amp Tscherne, H. secondary amputation following limb salvage in multiply traumatized patients Sehirlioglu, A.; Ozturk, C.; Painful neuroma requiring 2009 Int Orthop Patient/Injury factors for LS no controlled comparison Yazicioglu, K.; Tugcu, I.; surgical excision after lower or Amp Yilmaz, B.; Goktepe, A. S. limb amputation caused by landmine explosions Ghallab, N. H. Overview of vascular injuries in 2006 Surgical Practice Immediate amputation Mixed Etiology Yemen: Experience from a single factors; Patient/Injury tertiary referral hospital factors for LS or Amp Purcell, R. L.; Cody, J. P.; Outcomes of war related 2015 Injury Immediate amputation No comparison of interest Gordon, W.; Kilcoyne, K. femoral neck fractures factors; Patient/Injury factors for LS or Amp Junge, T.; Bellamy, J.; Outcomes of Talus Fractures 2017 Foot Ankle Int Immediate amputation very low quality Dowd, T.; Osborn, P. Associated With High-Energy factors Combat Trauma Badash, I.; Burtt, K. E.; Outcomes of Soft Tissue 2017 Am Surg Patient/Injury factors for LS no controlled comparison Leland, H. A.; Gould, D. J.; Reconstruction for Traumatic or Amp Rounds, A. D.; Azadgoli, Lower Extremity Fractures with B.; Patel, K. M.; Carey, J. Compromised Vascularity N. Burkhardt, G. E.; Cox, M.; Outcomes of selective tibial 2010 J Vasc Surg Immediate amputation Amputation/Salvage as Clouse, W. D.; Porras, C.; artery repair following combat- factors outcome Gifford, S. M.; Williams, related extremity injury K.; Propper, B. W.; Rasmussen, T. E. Ratnayake, A.; Outcomes of popliteal vascular 2014 Injury Immediate amputation Case series Samarasinghe, B.; Bala, M. injuries at Sri Lankan war-front factors military hospital: case series of 44 cases Spear, M. Outcomes of lower extremity 2009 Plast Surg Nurs Patient/Injury factors for LS Review injuries sustained during or Amp Operation Iraqi Freedom and Operation Enduring Freedom

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Ramasamy, A.; Hill, A. M.; Outcomes of IED foot and ankle 2013 J Bone Joint Surg Am Patient/Injury factors for LS uninterpretable Masouros, S.; Gibb, I.; blast injuries or Amp multivariate results and Phillip, R.; Bull, A. M.; univariate very low Clasper, J. C. Lee, J. H.; Chung, D. W.; Outcomes of anterolateral 2012 Microsurgery Environmental factors for LS No Controlled Comparison Han, C. S. thigh-free flaps and conversion or Amp from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures Penn-Barwell, J. G. Outcomes in lower limb 2011 Injury Systematic Reviews References Reviewed amputation following trauma: a systematic review and meta- analysis Matsumoto, S.; Jung, K.; Outcomes Comparison Between 2018 Ann Vasc Surg Patient/Injury factors for LS Amputation/Salvage as Smith, A.; Coimbra, R. Ligation and Repair after Major or Amp Outcome Lower Extremity Venous Injury Highsmith, M. J.; Nelson, Outcomes Associated With the 2016 Mil Med Systematic Reviews References Reviewed L. M.; Carbone, N. T.; Intrepid Dynamic Exoskeletal Klenow, T. D.; Kahle, J. T.; Orthosis (IDEO): A Systematic Hill, O. T.; Maikos, J. T.; Review of the Literature Kartel, M. S.; Randolph, B. J. Bosse, M. J.; Teague, D.; Outcomes After Severe Distal 2017 J Orthop Trauma Patient/Injury factors for LS Amputation/Salvage as Reider, L.; Gary, J. L.; Tibia, Ankle, and/or Foot or Amp; Environmental Outcome Morshed, S.; Seymour, R. Trauma: Comparison of Limb factors for LS or Amp B.; Toledano, J.; Cannada, Salvage Versus Transtibial L. K.; Steverson, B.; Amputation (OUTLET) Scharfstein, D. O.; Luly, J.; MacKenzie, E. J. Clasper, J. C.; Rowley, D. I. Outcome, following significant 2009 J Bone Joint Surg Br Patient/Injury factors for LS No controlled comparison delays in initial surgery, of or Amp ballistic femoral fractures managed without internal or external fixation

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Khan, M. I.; Zafar, A.; Outcome of tissue sparing 2006 J Coll Physicians Surg Immediate amputation *Mixed extremity Khan, N.; Saleem, M.; surgical intervention in mine Pak factors; Patient/Injury Mufti, N. blast limb injuries factors for LS or Amp Pappas, P. J.; Haser, P. B.; Outcome of complex venous 1997 J Vasc Surg Immediate amputation No Controlled Teehan, E. P.; Noel, A. A.; reconstructions in patients with factors Comparisons Silva, M. B., Jr.; Jamil, Z.; trauma Swan, K. G.; Padberg, F. T., Jr.; Hobson, R. W., 2nd Alexander, J. J.; Outcome of complex vascular 1991 Am J Surg Patient/Injury factors for LS not best available; very Piotrowski, J. J.; Graham, and orthopedic injuries of the or Amp low quality D.; Franceschi, D.; King, T. lower extremity Khaneja, S. C.; Arrillaga, Outcome in the management of 1994 Vascular Surgery Patient/Injury factors for LS no comparisons; case A.; Ernst, A.; Picard, D. L.; penetrating venous injury or Amp series Pizzi, W. F. Boraiah, S.; Kemp, T. J.; Outcome following open 2010 J Bone Joint Surg Am Patient/Injury factors for LS No RF of interest Erwteman, A.; Lucas, P. A.; reduction and internal fixation or Amp Asprinio, D. E. of open pilon fractures Hurowitz, E. J.; Gould, J. Outcome analysis of agility total 2007 Foot Ankle Int Patient/Injury factors for LS Mixed etiology S.; Fleisig, G. S.; Fowler, R. ankle replacement with prior or Amp adjunctive procedures: two to six year followup Kinner, B.; Tietz, S.; Outcome after complex trauma 2011 J Trauma Immediate amputation Mixed Etiology Muller, F.; Prantl, L.; of the foot factors; Patient/Injury Nerlich, M.; Roll, C. factors for LS or Amp Zivkovic, O.; Poljak- Our experience with modified 2009 Mil Med Patient/Injury factors for LS no RF of interest; Guberina, R.; Muljacic, A.; osteomyoplasty for or Amp Guberina, M. reamputation of war-related transtibial amputees Tribble, D. R.; Osteomyelitis Risk Factors 2018 J Orthop Trauma Immediate amputation Lewandowski, L. R.; Related to Combat Trauma factors; Patient/Injury Potter, B. K.; Petfield, J. L.; Open Tibia Fractures: A Case- factors for LS or Amp Stinner, D. J.; Ganesan, A.; Control Analysis Krauss, M.; Murray, C. K. Vallier, H. A.; Fitzgerald, S. Osteocutaneous pedicle flap 2012 J Bone Joint Surg Am Patient/Injury factors for LS 14 subjects included; J.; Beddow, M. E.; Sontich, transfer for salvage of transtibial or Amp J. K.; Patterson, B. M. amputation after severe lower- extremity injury

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Patterson, B. M.; Smith, A. Osteocutaneous pedicle flap of 2000 Journal of Trauma - Patient/Injury factors for LS case reports A.; Holdren, A. M.; the foot for salvage of below- Injury, Infection and or Amp Sontich, J. K. knee amputation level after Critical Care lower extremity injury Durrant, C. A.; Mackey, S. Orthoplastic classification 2011 Ann Plast Surg Patient/Injury factors for LS review P. systems: the good, the bad, and or Amp; Systematic Reviews the ungainly Jie, Q.; Yang, L.; Zhu, Q. S.; Orthopedic trauma of limbs 2007 Chin J Traumatol Patient/Injury factors for LS Mixed population Li, M. Q.; Li, Z.; Zhao, G. associated with vascular injuries or Amp Y.; Hu, Y. Y. Christensen, J.; Spence, S.; Orthopaedic Watercraft Injuries: 2018 J Orthop Trauma Patient/Injury factors for LS No controlled comparison Watson, D.; Shah, A.; Characterization of or Amp Maxson, B.; Infante, A.; Mechanisms, Fractures, and Sanders, R.; Mir, H. R. Complications in 216 Injuries Bar-On, E.; Lebel, E.; Orthopaedic management in a 2011 Injury Immediate amputation Mixed population Kreiss, Y.; Merin, O.; mega mass casualty situation. factors Benedict, S.; Gill, A.; Lee, The Israel Defence Forces Field E.; Pirotsky, A.; Shirov, T.; Hospital in Haiti following the Blumberg, N. January 2010 earthquake Lambert, E. W.; Simpson, Orthopaedic injuries among 2003 Journal of Immediate amputation Case series R. B.; Marzouk, A.; Unger, survivors of USS COLE attack Orthopaedic Trauma factors; Patient/Injury D. V. factors for LS or Amp Gandhi, R. R.; Overton, T. Optimal timing of femur 2014 Journal of Trauma Systematic Reviews References Reviewed L.; Haut, E. R.; Lau, B.; fracture stabilization in and Acute Care Vallier, H. A.; Rohs, T.; polytrauma patients: A practice Surgery Hasenboehler, E.; Lee, J. management guideline from the K.; Alley, D.; Watters, J.; Eastern Association for the Rogers, F. B.; Shafi, S. Surgery of Trauma Tintle, S. M.; Keeling, J. J.; Operative complications of 2011 J Bone Joint Surg Am Patient/Injury factors for LS No RF of interest; Forsberg, J. A.; Shawen, S. combat-related transtibial or Amp B.; Andersen, R. C.; Potter, amputations: a comparison of B. K. the modified burgess and modified Ertl tibiofibular synostosis techniques Andersen, R. C.; Wilson, K. Open, combat-related loss, or 2014 J Orthop Trauma Patient/Injury factors for LS <10 pts per group; W.; Bojescul, J. A.; Mickel, disruption of the knee extensor or Amp mechanism: treatment 132

T. J.; Gordon, W. T.; strategies, classification, and Potter, B. K. outcomes

Soucacos, P. N.; Beris, A. Open type IIIB and IIIC fractures 1995 Clin Orthop Relat Res Immediate amputation No Comparisons E.; Xenakis, T. A.; Malizos, treated by an orthopaedic factors; Patient/Injury K. N.; Vekris, M. D. microsurgical team factors for LS or Amp; Environmental factors for LS or Amp Melvin, J. S.; Dombroski, Open tibial shaft fractures: II. 2010 J Am Acad Orthop Patient/Injury factors for LS Review D. G.; Torbert, J. T.; Definitive management and Surg or Amp Kovach, S. J.; Esterhai, J. limb salvage L.; Mehta, S. Georgiadis, G. M.; Open tibial fractures with 1993 J Bone Joint Surg Am Immediate amputation prospective univariate; Behrens, F. F.; Joyce, M. J.; severe soft-tissue loss. Limb factors; Patient/Injury very low quality Earle, A. S.; Simmons, A. L. salvage compared with below- factors for LS or Amp; Cost the-knee amputation Analysis Georgiadis, G. M.; Open tibial fractures with 1993 Journal of Bone and Patient/Injury factors for LS Duplicate aricle; same as Behrens, F. F.; Joyce, M. J.; severe soft-tissue loss Joint Surgery - Series or Amp; Cost Analysis AAOS ID 2622 Earle, A. S.; Simmons, A. L. A Enninghorst, N.; Open tibia fractures: timely 2011 J Trauma Immediate amputation Mixed etiology McDougall, D.; Hunt, J. J.; debridement leaves injury factors; Patient/Injury Balogh, Z. J. severity as the only determinant factors for LS or Amp of poor outcome Dugan, T. R.; Hubert, M. Open supracondylar femur 2013 Injury Patient/Injury factors for LS No controlled comparison G.; Siska, P. A.; Pape, H. fractures with bone loss in the or Amp C.; Tarkin, I. S. polytraumatized patient - Timing is everything! Henning, J. A.; Jones, C. B.; Open reduction internal fixation 2009 Foot and Ankle Patient/Injury factors for LS Doesn't address question Sietsema, D. L.; Bohay, D. versus primary arthrodesis for International or Amp of interest; R.; Anderson, J. G. lisfranc injuries: A prospective randomized study Lawrence, S. J.; Singhal, Open hindfoot injuries 2007 J Am Acad Orthop Systematic Reviews review M. Surg Heier, K. A.; Infante, A. F.; Open fractures of the calcaneus: 2003 J Bone Joint Surg Am Immediate amputation No comparison of interest Walling, A. K.; Sanders, R. soft-tissue injury determines factors; Patient/Injury W. outcome factors for LS or Amp

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Tajsic, N. B.; Sambath, P.; Open Fracture Management in 2017 World J Surg Environmental factors for LS No relevant RFs Nguon, S.; Sokh, V.; Low-Resource Settings: A or Amp Chheang, V.; Landsem, G.; Medical Training Experience in Zaletel, I.; Husum, H. Cambodian Hospitals Wright, D. G.; Covey, D. C.; Open dislocation of the knee 1995 J Orthop Trauma Patient/Injury factors for LS 18 subjects included; no Born, C. T.; Sadasivan, K. or Amp comparisons K. Worsham, J. R.; Elliott, M. Open Calcaneus Fractures and 2016 J Foot Ankle Surg Immediate amputation No Controlled Comparison R.; Harris, A. M. Associated Injuries factors; Patient/Injury factors for LS or Amp; Environmental factors for LS or Amp Yazar, S.; Lin, C. H.; Wei, F. One-stage reconstruction of 2004 Plast Reconstr Surg Patient/Injury factors for LS case series C. composite bone and soft-tissue or Amp defects in traumatic lower extremities Fuzier, R.; Rousset, J.; One half of patients reports 2015 Anaesthesia Critical Patient/Injury factors for LS No relevant RFs; no Bataille, B.; Salces-y- persistent pain three months Care and Pain or Amp; Environmental comparison group NÃ©dÃ©o, A.; MaguÃ¨s, after orthopaedic surgery Medicine factors for LS or Amp J. P. Hertel, R.; Lambert, S. M.; On the timing of soft-tissue 1999 Archives of Immediate amputation No controlled comparisons MÃ¼ller, S.; Ballmer, F. T.; reconstruction for open Orthopaedic and factors Ganz, R. fractures of the lower leg Trauma Surgery Dua, A.; Desai, S. S.; Observation may be an 2015 Vascular Immediate amputation Unclear Etiology ; no Johnston, S.; inadequate approach for injured factors; Patient/Injury controlled comparison Chinapuvvula, N. R.; extremities with single tibial factors for LS or Amp DuBose, J.; Charlton-Ouw, vessel run-off K.; Azizzadeh, A.; Burgess, A.; Wade, C. E.; Fox, C. J.; Holcomb, J. B. Johansen, K.; Daines, M.; Objective criteria accurately 1990 J Trauma Cost Analysis Amp/Sal as outcome - only Howey, T.; Helfet, D.; predict amputation following use for cost analysis Hansen, S. T., Jr. lower extremity trauma Schlatterer, D. R.; Negative pressure wound 2015 Clin Orthop Relat Res Systematic Reviews References Reviewed Hirschfeld, A. G.; Webb, L. therapy in grade IIIB tibial X. fractures: fewer infections and fewer flap procedures? 134

Kauvar, D. S.; Sarfati, M. National trauma databank 2011 J Vasc Surg Immediate amputation Amputation/Salvage as R.; Kraiss, L. W. analysis of mortality and limb factors outcome loss in isolated lower extremity vascular trauma Zayed, M.; Bech, F.; National review of factors 2014 Ann Vasc Surg Immediate amputation No trauma Hernandez-Boussard, T. influencing disparities and types factors of major lower extremity amputations Kim, J. J.; Kelly, Iv J. D. Multiple ligament injured knee: 2003 Current Opinion in Immediate amputation Commentary Priorities and treatment options Orthopaedics factors; Patient/Injury factors for LS or Amp Krishnan, A.; Pamecha, C.; Modified Ilizarov technique for 2006 J Orthop Surg (Hong Immediate amputation case series Patwa, J. J. infected nonunion of the femur: Kong) factors the principle of distraction- compression osteogenesis Ramasamy, A.; Hill, A. M.; The modern "deck-slap" injury- 2011 Journal of Trauma - Patient/Injury factors for LS Prospective univariate; No Phillip, R.; Gibb, I.; Bull, A. calcaneal blast fractures from Injury, Infection and or Amp Controlled Comparisons M. J.; Clasper, J. C. vehicle explosions Critical Care Bevevino, A. J.; Dickens, J. A model to predict limb salvage 2014 Clin Orthop Relat Res Immediate amputation inadequate data on F.; Potter, B. K.; Dworak, in severe combat-related open factors; Patient/Injury individual risk factors to T.; Gordon, W.; Forsberg, calcaneus fractures factors for LS or Amp answer the pico question. J. A. compares overall model fit between multiple logistic regression and neural network model, and not the individual risk factors relevant to the PICO question Li, W. S.; Chan, S. Y.; Chau, Mobility, prosthesis use and 2018 Prosthet Orthot Int Environmental factors for LS No relevant RFs W. W.; Law, S. W.; Chan, health-related quality of life of or Amp K. M. bilateral lower limb amputees from the 2008 Sichuan earthquake Nikolic, D.; Draskovic, V.; Missile injuries of the knee joint 2000 Injury Patient/Injury factors for LS prospective univariate; Vulovic, R.; Mladenovic, or Amp very low quality M.

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Has, B.; Jovanovic, S.; Minimal fixation in the 2001 Croat Med J Immediate amputation No comparison of interest Wertheimer, B.; Kondza, treatment of open hand and factors; Patient/Injury G.; Grdic, P.; Leko, K. foot bone fractures caused by factors for LS or Amp explosive devices: case series Rivera, J. C.; Greer, R. M.; The Military Orthopedic Trauma 2016 J Trauma Acute Care Patient/Injury factors for LS No controlled comparisons Spott, M. A.; Johnson, A. Registry: The potential of a Surg or Amp E. specialty specific process improvement tool Doukas, W. C.; Hayda, R. The Military Extremity Trauma 2013 J Bone Joint Surg Am Systematic Reviews References Reviewed A.; Frisch, H. M.; Amputation/Limb Salvage Andersen, R. C.; Mazurek, (METALS) study: outcomes of M. T.; Ficke, J. R.; Keeling, amputation versus limb salvage J. J.; Pasquina, P. F.; Wain, following major lower-extremity H. J.; Carlini, A. R.; trauma MacKenzie, E. J. Melcer, T.; Walker, G. J.; Midterm health and personnel 2010 Mil Med Environmental factors for LS No controlled comparison; Galarneau, M.; Belnap, B.; outcomes of recent combat or Amp No relevant RFs Konoske, P. amputees Isenberg, J. S.; Costigan, Microvascular transplantation in 1996 Ann Plast Surg Patient/Injury factors for LS Wrong population W. the salvage of lower extremity or Amp (elderly); only 10 subjects trauma in the elderly included Francel, T. J.; Vander Kolk, Microvascular soft-tissue 1992 Plast Reconstr Surg Patient/Injury factors for LS mixed etiology C. A.; Hoopes, J. E.; transplantation for or Amp Manson, P. N.; reconstruction of acute open Yaremchuk, M. J. tibial fractures: timing of coverage and long-term functional results Peat, B. G.; Liggins, D. F. Microvascular soft tissue 1990 Ann Plast Surg retrospective, univariate - reconstruction for acute tibial very low quality fractures--late complications and the role of bone grafting Klem, C.; Sniezek, J. C.; Microvascular reconstructive 2013 J Trauma Acute Care Immediate amputation Mixed Population Moore, B.; Davis, M. R.; surgery in Operations Iraqi and Surg factors; Patient/Injury Coppit, G.; Schmalbach, C. Enduring Freedom: the US factors for LS or Amp military experience performing free flaps in a combat zone

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Santanelli di Pompeo, F.; Microvascular reconstruction of 2015 Injury Patient/Injury factors for LS Mixed etiology Pugliese, P.; Sorotos, M.; complex foot defects, a new or Amp Rubino, C.; Paolini, G. anatomo-functional classification Musharrafieh, R.; Osmani, Microvascular composite tissue 1999 J Reconstr Microsurg Patient/Injury factors for LS case series O.; Saghieh, S.; Elhassan, transfer for the management of or Amp B.; Atiyeh, B. type IIIB and IIIC fractures of the distal leg and compound foot fractures Xiong, L.; Gazyakan, E.; Microsurgical reconstruction for 2016 Injury Immediate amputation Unclear etiology WÃ¤hmann, M.; Bigdeli, postâ??traumatic defects of factors A.; Kremer, T.; Harhaus, lower leg in the elderly: A L.; Sun, J.; Kneser, U.; comparative study Hirche, C. Starnes-Roubaud, M. J.; Microsurgical Lower Extremity 2015 Plast Reconstr Surg Patient/Injury factors for LS Peric, M.; Chowdry, F.; Reconstruction in the Subacute Glob Open or Amp Nguyen, J. T.; Schooler, Period: A Safe Alternative W.; Sherman, R.; Carey, J. N. Ninkovic, M.; Voigt, S.; Microsurgical Advances in 2012 Clinics in Plastic Immediate amputation Commentary Dornseifer, U.; Lorenz, S.; Extremity Salvage Surgery factors; Patient/Injury Ninkovic, M. factors for LS or Amp; Environmental factors for LS or Amp Perkins, Z. B.; Yet, B.; Meta-analysis of prognostic 2015 Br J Surg Systematic Reviews References Reviewed Glasgow, S.; Cole, E.; factors for amputation following Marsh, W.; Brohi, K.; surgical repair of lower Rasmussen, T. E.; Tai, N. R. extremity vascular trauma Akula, M.; Gella, S.; Shaw, A meta-analysis of amputation 2011 Injury Systematic Reviews References Reviewed C. J.; McShane, P.; versus limb salvage in mangled Mohsen, A. M. lower limb injuries--the patient perspective Penn-Barwell, J. G.; Myatt, Medium-term outcomes 2015 Injury Patient/Injury factors for LS prospective univariate; R. W.; Bennett, P. M.; following limb salvage for or Amp Sargeant, I. D. severe open tibia fracture are similar to trans-tibial amputation

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Dharm-Datta, S.; Medical lessons learnt from the 2013 J R Army Med Corps review McLenaghan, J. US and Canadian experience of treating combat casualties from Afghanistan and Iraq Momoh, A. O.; Chung, K. Measuring outcomes in lower 2013 Clin Plast Surg Systematic Reviews References Reviewed C. limb surgery Roorda, L. D.; Roebroeck, Measuring activity limitations in 2005 Archives of Physical Doesn't address question M. E.; Van Tilburg, T.; walking: Development of a Medicine and of interest; Molenaar, I. W.; hierarchical scale for patients Rehabilitation Lankhorst, G. J.; Bouter, L. with lower-extremity disorders M. who live at home Fodor, L.; Sobec, R.; Sita- Mangled lower extremity: can 2012 Int J Burns Trauma Systematic Reviews References Reviewed Alb, L.; Fodor, M.; Ciuce, we trust the amputation scores? C. Poole, G. V.; Agnew, S. G.; The mangled lower extremity: 1994 Am Surg Immediate amputation Amputation/Salvage as Griswold, J. A.; Rhodes, R. can salvage be predicted? factors outcome; too few pts; no S. controlled comparison Hoogendoorn, J. M.; Van The mangled leg. Decision- 2002 European Journal of Immediate amputation Review der Werken, C. making based on scoring Trauma factors; Patient/Injury systems and outcome factors for LS or Amp Shawen, S. B.; Keeling, J. The mangled foot and leg: 2010 Foot Ankle Clin Immediate amputation review J.; Branstetter, J.; Kirk, K. salvage versus amputation factors L.; Ficke, J. R. Hallock, G. G. The mangled foot and ankle: 2014 Clin Podiatr Med Systematic Reviews review soft tissue salvage techniques Surg Roessler, M. S.; Wisner, D. The mangled extremity. When 1991 Arch Surg Immediate amputation retrospective, no H.; Holcroft, J. W. to amputate? factors controlled comparison Beranger, F.; Lesquen, H. Management of war-related 2017 Injury Immediate amputation Mixed population D.; Aoun, O.; Roqueplo, vascular wounds in French role factors; Patient/Injury C.; Meyrat, L.; Natale, C.; 3 hospital during the Afghan factors for LS or Amp Avaro, J. P. campaign Jawas, A.; Abbas, A. K.; Management of war-related 2013 World J Emerg Surg Patient/Injury factors for LS No controlled comparison Nazzal, M.; Albader, M.; vascular injuries: experience or Amp Abu-Zidan, F. M. from the second gulf war

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Al-Ganadi, A. Management of Vascular Injury 2015 Ann Vasc Surg Patient/Injury factors for LS no controlled comparison; during Current Peaceful Yemeni or Amp case series Revolution Trooskin, S. Z.; Sclafani, S.; The management of vascular 1993 Surg Gynecol Obstet Patient/Injury factors for LS Mixed population Winfield, J.; Duncan, A. O.; injuries of the extremity or Amp Scalea, T.; Vieux, E.; associated with civilian firearms Atweh, N.; Gertler, J. Kurtoglu, M.; Ertekin, C.; Management of vascular 1991 Int Angiol Immediate amputation *Mixed population (lower Bulut, T.; Belgerden, S.; injuries of the extremities. One factors; Patient/Injury and upper extremities) Genc, F. A. hundred and fifteen cases factors for LS or Amp Sciarretta, J. D.; Macedo, Management of traumatic 2015 Int J Surg Patient/Injury factors for LS retrospective univariate; F. I.; Otero, C. A.; popliteal vascular injuries in a or Amp no RF of interest Figueroa, J. N.; Pizano, L. level I trauma center: A 6-year R.; Namias, N. experience Pipitone, P. S.; Rehman, S. Management of Traumatic Bone 2014 Orthopedic Clinics of Immediate amputation Review Loss in the Lower Extremity North America factors; Patient/Injury factors for LS or Amp Small, J. O.; Mollan, R. A. Management of the soft tissues 1992 Br J Plast Surg Patient/Injury factors for LS Case series; no controlled in open tibial fractures or Amp comparison Naique, S. B.; Pearse, M.; Management of severe open 2006 J Bone Joint Surg Br Patient/Injury factors for LS No RF of interest; Nanchahal, J. tibial fractures: the need for or Amp combined orthopaedic and plastic surgical treatment in specialist centres Khan, U.; Smitham, P.; Management of severe open 2007 Plastic and Patient/Injury factors for LS too few pts; prospective Pearse, M.; Nanchahal, J. ankle injuries Reconstructive or Amp univariate; Surgery Greer, L. T.; Patel, B.; Via, Management of secondary 2012 J Trauma Acute Care Patient/Injury factors for LS case series K. C.; Bowman, J. N.; hemorrhage from early graft Surg or Amp Weber, M. A.; Fox, C. J. failure in military extremity wounds Sultan, S.; Shah, A. A. Management of open tibial 2001 J Ayub Med Coll Patient/Injury factors for LS case series fractures at Ayub Teaching Abbottabad or Amp Hospital, Abbottabad Hull, P. The management of open tibial 2008 European Journal of Patient/Injury factors for LS Review fractures Orthopaedic Surgery or Amp and Traumatology 139

Whitaker, I. S.; Rozen, W. The management of open lower 2011 Annals of plastic Immediate amputation Review M.; Shokrollahi, K. limb fractures: the journey from surgery factors amputation to evidence-based reconstruction and harpsichords Atef, A.; El-Tantawy, A. Management of open infected 2014 Eur J Orthop Surg Patient/Injury factors for LS No controlled comparison comminuted tibial fractures Traumatol or Amp using Ilizarov concept Seligson, D.; Ostermann, The management of open 1994 J Trauma Immediate amputation No Controlled P. A.; Henry, S. L.; Wolley, fractures associated with factors; Patient/Injury Comparison; Mixed T. arterial injury requiring vascular factors for LS or Amp; Etiology; Mixed Population repair Environmental factors for LS or Amp McKinley, T. O.; Management of Mangled 2018 J Orthop Trauma Systematic Reviews review D'Alleyrand, J. C.; Valerio, Extremities and Orthopaedic I.; Schoebel, S.; Tetsworth, War Injuries K.; Elster, E. A. Lu, Y.; Huang, Y.; Zhao, L.; Management of major arterial 1993 Iowa Orthop J Patient/Injury factors for LS mixed extremity; case Li, R.; Shi, K.; Ma, P.; Chu, injuries of the limbs in 166 cases or Amp series; X. Martin, L. C.; McKenney, Management of lower extremity 1994 J Trauma Patient/Injury factors for LS No RF of interest; M. G.; Sosa, J. L.; arterial trauma or Amp Ginzburg, E.; Puente, I.; Sleeman, D.; Zeppa, R. Pourzand, A.; Fakhri, B. A.; Management of high-risk 2010 Vasc Health Risk Immediate amputation Amputation/Salvage as Azhough, R.; popliteal vascular blunt trauma: Manag factors outcome Hassanzadeh, M. A.; clinical experience with 62 cases Hashemzadeh, S.; Bayat, A. M. Ramasamy, P. R. Management of Gustilo 2017 Indian J Orthop Immediate amputation No controlled comparison Anderson III B open tibial factors; Patient/Injury fractures by primary fascio- factors for LS or Amp septo-cutaneous local flap and primary fixation: The 'fix and shift' technique Harjai, M. M.; Agarwal, D. Management of Combat 2007 Med J Armed Forces Patient/Injury factors for LS No controlled comparison; C.; Kumar, S.; Dave, P.; Related Vascular Injuries in a India or Amp case series Jog, S. S. Zonal Hospital 140

Gray, J. L. Management of Arterial and 2015 Operative Systematic Reviews review Venous Injuries in the Techniques in Sports Dislocated Knee Medicine Bennett, P. M.; Sargeant, The management and outcome 2015 Bone Joint J Patient/Injury factors for LS No comparison group I. D.; Myatt, R. W.; Penn- of open fractures of the femur or Amp Barwell, J. G. sustained on the battlefield over a ten-year period Coupland, R. M. A management algorithm for 1990 Injury Patient/Injury factors for LS No usable data chronically exposed war wounds or Amp of bone Karavias, D.; Korovessis, Major vascular lesions 1992 J Orthop Trauma Patient/Injury factors for LS No Controlled Comparison P.; Filos, K. S.; Siamplis, D.; associated with orthopaedic or Amp Petrocheilos, J.; injuries Androulakis, J. Akiode, O.; Shonubi, A. Major limb amputations: an 2005 J Natl Med Assoc Patient/Injury factors for LS Mixed population; unclear M.; Musa, A.; Sule, G. audit of indications in a or Amp trauma suburban surgical practice Copuroglu, C.; Heybeli, N.; Major extremity injuries 2012 The Scientific World Immediate amputation *Mixed population (lower Ozcan, M.; Yilmaz, B.; associated with farmyard Journal factors; Patient/Injury and upper extremities) Ciftdemir, M.; Copuroglu, accidents factors for LS or Amp E. Farrokhi, S.; Perez, K.; Major deployment-related 2018 Msmr Patient/Injury factors for LS No risk factors of interest; Eskridge, S.; Clouser, M. amputations of lower and upper or Amp no controlled comparison limbs, active and reserve components, U.S. Armed Forces, 2001-2017 Bhatnagar, V.; Richard, E.; Lower-limb amputation and 2015 J Rehabil Res Dev Cost Analysis Melcer, T.; Walker, J.; effect of posttraumatic stress Galarneau, M. disorder on Department of Veterans Affairs outpatient cost trends Kaczynski, J.; Dillon, M.; Lower limb trauma: limb salvage 2012 Pol Przegl Chir Immediate amputation review Hilton, J. or an early amputation? factors Fasika, O. M.; Stilwell, J. Lower limb trauma: a review of 1994 East Afr Med J Patient/Injury factors for LS Unclear trauma; no H. 40 cases treated at the regional or Amp relevant RF burns and plastic surgery unit, Merseyside, England 141

Pretre, R.; Bruschweiler, Lower limb trauma with injury 1996 J Trauma Patient/Injury factors for LS No Controlled Comparison I.; Rossier, J.; Chilcott, M.; to the popliteal vessels or Amp Bednarkiewicz, M.; Kursteiner, K.; Kalangos, A.; Hoffmeyer, P.; Faidutti, B. Baque, P.; Trojani, C.; Lower limb trauma caused by 1998 J Trauma Immediate amputation No controlled comparison Batt, M.; Hassen-Khodja, power-driven cultivators: report factors R.; Bariseel, H.; Pittaluga, of 23 cases P.; Declemy, S.; Prate, B.; Le Bas, P. Tomaino, M. M. Lower limb salvage: 1995 Orthopedics Systematic Reviews review microvascular reconstruction of post-traumatic soft tissue and skeletal defects Mardian, S.; Schaser, K. Lower limb salvage: indication 2014 Acta Chir Orthop Systematic Reviews References Reviewed D.; Wichlas, F.; Jakobs, C.; and decision making for Traumatol Cech Kraphol, B.; Schwabe, P. replantation, revascularisation and amputation Ong, Y. S.; Levin, L. S. Lower limb salvage in trauma 2010 Plast Reconstr Surg Systematic Reviews review Battiston, B.; Tos, P.; Lower limb replantations: 2002 Microsurgery Immediate amputation No Controlled Comparison Pontini, I.; Ferrero, S. indications and a new scoring factors system Necmioglu, S.; Subasi, M.; Lower limb landmine injuries 2004 Prosthet Orthot Int Immediate amputation No Controlled Comparison Kayikci, C.; Young, D. B. factors; Patient/Injury factors for LS or Amp Jacobs, N.; Rourke, K.; Lower limb injuries caused by 2014 Injury Patient/Injury factors for LS No controlled comparison Rutherford, J.; Hicks, A.; improvised explosive devices: or Amp Smith, S. R.; Templeton, proposed 'Bastion classification' P.; Adams, S. A.; Jansen, J. and prospective validation O. Oostenbroek, H. J.; Brand, Lower limb deformity due to 2009 Acta Orthop Patient/Injury factors for LS not best available; very R.; van Roermund, P. M. failed trauma treatment or Amp low quality corrected with the Ilizarov technique: factors affecting the complication rate in 52 patients

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Kidmas, A. T.; Nwadiaro, Lower limb amputation in Jos, 2004 East Afr Med J Immediate amputation Mixed etiology C. H.; Igun, G. O. Nigeria factors Walker, C. R.; Ingram, R. Lower limb amputation 1994 Injury Patient/Injury factors for LS No RF of interest R.; Hullin, M. G.; following injury: a survey of or Amp McCreath, S. W. long-term functional outcome Hierner, R.; Berger, A. K.; Lower leg replantation-- 2007 Microsurgery Systematic Reviews References Reviewed Frederix, P. R. decision-making, treatment, and long-term results Zaraca, F.; Ponzoni, A.; Lower extremity traumatic 2011 Minerva Chir Immediate amputation prospective univariate; Stringari, C.; Ebner, J. A.; vascular injury at a level II factors very low quality Giovannetti, R.; Ebner, H. trauma center: an analysis of limb loss risk factors and outcomes Tampe, U.; Weiss, R. J.; Lower extremity soft tissue 2014 BMC Surg Patient/Injury factors for LS mixed etiology Stark, B.; Sommar, P.; Al reconstruction and amputation or Amp Dabbagh, Z.; Jansson, K. A. rates in patients with open tibial fractures in Sweden during 1998-2010 Tampe, U., Widmer, L. W., Mortality, risk factors and 2018 Scand J Trauma Immediate amputation Confounded comparison Weiss, R. J., Jansson, K causes of death in Swedish Resusc Emerg Med factors patients with open tibial fractures - a nationwide study of 3, 777 patients Starman, J. S.; Castillo, R. Proximal tibial metaphyseal 2010 Clin Orthop Relat Res Patient/Injury factors for LS Very Low Quality C.; Bosse, M. J.; fractures with severe soft tissue or Amp MacKenzie, E. J. injury: clinical and functional results at 2 years Franco, M. J.; Nicoson, M. Lower Extremity Reconstruction 2017 J Reconstr Microsurg Patient/Injury factors for LS No usable data C.; Parikh, R. P.; Tung, T. with Free Gracilis Flaps or Amp H. Heller, L.; Levin, L. S. Lower extremity microsurgical 2001 Plastic and Immediate amputation Review reconstruction Reconstructive factors; Patient/Injury Surgery factors for LS or Amp; Environmental factors for LS or Amp

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Bibbo, C.; Nelson, J.; Lower Extremity Limb Salvage 2015 J Orthop Trauma Patient/Injury factors for LS Unclear trauma Fischer, J. P.; Wu, L. C.; After Trauma: Versatility of the or Amp Low, D. W.; Mehta, S.; Anterolateral Thigh Free Flap Kovach, S. J.; Levin, L. S. Wells, M. D.; Bowen, C. V.; Lower extremity free flaps: a 1996 Can J Surg Patient/Injury factors for LS Mixed etiology; Manktelow, R. T.; review or Amp Graham, J.; Boyd, J. B. Tintle, S. M.; Forsberg, J. Lower extremity combat-related 2010 J Surg Orthop Adv Immediate amputation Review A.; Keeling, J. J.; Shawen, amputations factors S. B.; Potter, B. K. Higgins, T. F.; Klatt, J. B.; Lower Extremity Assessment 2010 Orthopedic Clinics of Immediate amputation Review Beals, T. C. Project (LEAP) - The Best North America factors; Patient/Injury Available Evidence on Limb- factors for LS or Amp; Threatening Lower Extremity Environmental factors for LS Trauma or Amp Hafez, H. M.; Woolgar, J.; Lower extremity arterial injury: 2001 J Vasc Surg Immediate amputation Amputation/Salvage as Robbs, J. V. results of 550 cases and review factors outcome of risk factors associated with limb loss Topal, A. E.; Eren, M. N.; Lower extremity arterial injuries 2010 Vasc Health Risk Patient/Injury factors for LS Amp/Sal as outcome Celik, Y. over a six-year period: Manag or Amp outcomes, risk factors, and management Perkins, Z. B.; Yet, B.; Long-term, patient-centered 2018 J Trauma Acute Care Patient/Injury factors for LS prospective univariate; Glasgow, S.; Marsh, D. W. outcomes of lower-extremity Surg or Amp R.; Tai, N. R. M.; vascular trauma Rasmussen, T. E. Esfandiari, E.; Yavari, A.; Long-term symptoms and 2018 Acta Orthop Patient/Injury factors for LS No usable data; does not Karimi, A.; Masoumi, M.; function after war-related lower Traumatol Turc or Amp address question of Soroush, M.; Saeedi, H. limb amputation: A national interest; cross-sectional study Lowenberg, D. W.; Buntic, Long-term results and costs of 2013 J Orthop Trauma Immediate amputation No controlled R. F.; Buncke, G. M.; muscle flap coverage with factors comparisons; No RF of Parrett, B. M. Ilizarov bone transport in lower interest limb salvage

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Giannoudis, P. V.; Long-term quality of life in 2009 Injury Patient/Injury factors for LS mixed etiology Harwood, P. J.; Kontakis, trauma patients following the or Amp G.; Allami, M.; full spectrum of tibial injury Macdonald, D.; Kay, S. P.; (fasciotomy, closed fracture, Kind, P. grade IIIB/IIIC open fracture and amputation) Ebrahimzadeh, M. H.; Long-term outcomes of patients 2007 J Foot Ankle Surg Patient/Injury factors for LS No RF of interest Rajabi, M. T. undergoing war-related or Amp amputations of the foot and ankle Finkler, E. S.; Marchwiany, Long-term Outcomes Following 2017 Foot Ankle Int Patient/Injury factors for LS Mixed etiology D. A.; Schiff, A. P.; Pinzur, Syme's Amputation or Amp M. S. Nithyananth, M.; Long-term outcome of high- 2011 J Trauma Patient/Injury factors for LS Too few pts per group Boopalan, P. R.; Titus, V. energy open Lisfranc injuries: a or Amp T.; Sundararaj, G. D.; Lee, retrospective study V. N. Dougherty, P. J. Long-term follow-up study of 1999 J Bone Joint Surg Am Patient/Injury factors for LS No comparisons bilateral above-the-knee or Amp amputees from the Vietnam War Dougherty, P. J. Long-term follow-up of 2003 J Trauma Patient/Injury factors for LS prospective univariate; no unilateral transfemoral or Amp RF of interest amputees from the Vietnam war Dua, A.; Patel, B.; Kragh, J. Long-term follow-up and 2012 J Trauma Acute Care Patient/Injury factors for LS Mixed extremity F., Jr.; Holcomb, J. B.; Fox, amputation-free survival in 497 Surg or Amp C. J. casualties with combat-related vascular injuries and damage- control resuscitation Williams, M. O. Long-term cost comparison of 1994 Clin Orthop Relat Res Patient/Injury factors for LS cost analysis; too few pts major limb salvage using the or Amp Ilizarov method versus amputation Ebrahimzadeh, M. H.; Long-term clinical outcomes of 2013 J Bone Joint Surg Am Patient/Injury factors for LS No controlled comparisons Kachooei, A. R.; Soroush, war-related hip disarticulation or Amp and transpelvic amputation

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Ebrahimzadeh, M. H.; Long-term clinical outcomes of 2015 Injury Patient/Injury factors for LS No RF of interest; No Moradi, A.; Khorasani, M. war-related bilateral lower or Amp controlled comparison R.; Hallaj-Moghaddam, extremities amputations M.; Kachooei, A. R. Zhou, Y.; Wang, Y.; Liu, L.; Locking compression plate as an 2015 Int Orthop Patient/Injury factors for LS No outcomes of interest Zhou, Z.; Cao, X. external fixator in the treatment or Amp of closed distal tibial fractures Dorweiler, B.; Neufang, Limb trauma with arterial injury: 2003 Thorac Cardiovasc Patient/Injury factors for LS Mixed population; A.; Schmiedt, W.; long-term performance of Surg or Amp Hessmann, M. H.; Rudig, venous interposition grafts L.; Rommens, P. M.; Oelert, H. Mangan, K. I.; Kingsbury, Limb Salvage With Intrepid 2016 J Orthop Trauma Environmental factors for LS univariate - very low T. D.; Mazzone, B. N.; Dynamic Exoskeletal Orthosis or Amp quality Wyatt, M. P.; Kuhn, K. M. Versus Transtibial Amputation: A Comparison of Functional Gait Outcomes Russell, W. L.; Sailors, D. Limb salvage versus traumatic 1991 Annals of Surgery Immediate amputation very low quality M.; Whittle, T. B.; Fisher amputation: A decision based factors Jr, D. F.; Burns, R. P. on a seven-part predictive index Helfet, D. L.; Howey, T.; Limb salvage versus 1990 Clin Orthop Relat Res Immediate amputation have workgroup review Sanders, R.; Johansen, K. amputation. Preliminary results factors population; no controlled of the Mangled Extremity comparisons; prospective Severity Score univariate; very low quality Rosenberg, G. A.; Limb salvage versus amputation 1998 Orthopedics Immediate amputation book chapter; review Patterson, B. M. for severe open fractures of the factors tibia Dalman, R. L.; Harris, E. J., Limb salvage surgery in spinal 1998 Ann Vasc Surg Follow-up available for Jr.; Walker, M. T.; cord injury patients only 7 patients; Perkash, I.

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Redett, R. J.; Robertson, B. Limb salvage of lower-extremity 2000 Plastic and Patient/Injury factors for LS No controlled comparison; C.; Chang, B.; Girotto, J.; wounds using free gracilis Reconstructive or Amp Vaughan, T. muscle reconstruction Surgery O'Sullivan, S. T.; Hehir, D. Limb salvage in vascular trauma 1994 Ir J Med Sci Amp/Sal as outcome; J.; O'Connor, M.; Brady, of the extremities--a regional retrospective univariate M. P.; O'Donnell, J. A. experience Mullenix, P. S.; Steele, S. Limb salvage and outcomes 2006 J Vasc Surg Immediate amputation Amp/Salv as outcome R.; Andersen, C. A.; among patients with traumatic factors; Patient/Injury Starnes, B. W.; Salim, A.; popliteal vascular injury: an factors for LS or Amp Martin, M. J. analysis of the National Trauma Data Bank Vielgut, I.; Gregori, M.; Limb salvage and functional 2015 Wien Klin Immediate amputation amputation/salvage as Holzer, L. A.; Glehr, M.; outcomes among patients with Wochenschr factors outcome; prospective Hashemi, S.; Platzer, P. traumatic popliteal artery injury: univariate; very low a review of 64 cases quality Sugun, T. S.; Ozaksar, K.; Limb salvage and amputation in 2013 Acta Orthop Immediate amputation univariate - mean dif; not Toros, T.; Kayalar, M.; Bal, Type 3C tibial fractures Traumatol Turc factors best available E.; Ozerkan, F. Casey, K.; Sabino, J.; Limb salvage after vascular 2015 J Vasc Surg Patient/Injury factors for LS *mixed-upper & lower Weiss, J. S.; Kumar, A.; reconstruction followed by or Amp extremity* Valerio, I. tissue transfer during the Global War on Terror Guerrero, A.; Gibson, K.; Limb loss following lower 2002 Injury Patient/Injury factors for LS not best available; very Kralovich, K. A.; Pipinos, I.; extremity arterial trauma: what or Amp low quality; Agnostopolous, P.; Carter, can be done proactively? Y.; Bulger, E.; Meissner, M.; Karmy-Jones, R. Sie Essoh, J. B.; Kodo, M.; Limb amputations in adults in an 2009 Niger J Clin Pract Immediate amputation *Mixed population (lower Dje Bi Dje, V.; Lambin, Y. Ivorian teaching hospital factors; Patient/Injury and upper extremities) factors for LS or Amp Garcia, A. F.; Sanchez, A. Limb amputation among 2012 Eur J Trauma Emerg Immediate amputation not best available; very I.; Millan, M.; Carbonell, J. patients with surgically treated Surg factors low quality P.; Ferrada, R.; Gutierrez, popliteal arterial injury: analysis M. I.; Peitzman, A. B.; of 15 years of experience in an Puyana, J. C. urban trauma center in Cali, Colombia

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Ebskov, L. B. Level of lower limb amputation 1992 Prosthet Orthot Int Patient/Injury factors for LS Mixed etiology; in relation to etiology: an or Amp epidemiological study Krueger, C. A.; Rivera, J. Late amputation may not 2015 Injury Patient/Injury factors for LS case series; mixed C.; Tennent, D. J.; Sheean, reduce complications or or Amp entremity A. J.; Stinner, D. J.; improve mental health in Wenke, J. C. combat-related, lower extremity limb salvage patients Dziekiewicz, M.; Obara, Large vessel injuries - Own 2007 Acta Angiologica Patient/Injury factors for LS Case series; no controlled A.; MaruszyÅ?ski, M.; experience or Amp comparisons Najdecki, M.; PaÅ?nik, K.; Przystasz, T. Patterson, B. M.; Agel, J.; Knee dislocations with vascular 2007 J Trauma Patient/Injury factors for LS no comparisons Swiontkowski, M. F.; injury: outcomes in the Lower or Amp Mackenzie, E. J.; Bosse, M. Extremity Assessment Project J. (LEAP) Study Merrill, K. D. Knee dislocations with vascular 1994 Orthopedic Clinics of review injuries North America Carr, J. B.; Werner, B. C.; Knee Dislocation in the Morbidly 2016 J Knee Surg Systematic Reviews review Miller, M. D.; Gwathmey, Obese Patient F. W. Gallusser, N.; Goetti, P.; Knee arthrodesis with modular 2015 European Journal of 12 subjects (with Luyet, A.; Borens, O. nail after failed TKA due to Orthopaedic Surgery outcomes reported) infection and Traumatology Garberina, M. J.; Fitch, R. Knee arthrodesis with circular 2001 Clin Orthop Relat Res Patient/Injury factors for LS Mixed etiology D.; Hoffmann, E. D.; external fixation or Amp Hardaker, W. T.; Vail, T. P.; Scully, S. P. De Vil, J.; Almqvist, K. F.; Knee arthrodesis with an 2008 Knee Surg Sports Doesn't address question Vanheeren, P.; Boone, B.; intramedullary nail: a Traumatol Arthrosc of interest; Verdonk, R. retrospective study Lerner, A.; Fodor, L.; Is staged external fixation a 2006 Clin Orthop Relat Res Patient/Injury factors for LS Mixed population Soudry, M. valuable strategy for war or Amp injuries to the limbs?

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O'Sullivan, S. T.; Is it possible to predict limb 1997 Injury Immediate amputation very low quality O'Sullivan, M.; Pasha, N.; viability in complex Gustilo IIIB factors O'Shaughnessy, M.; and IIIC tibial fractures? A O'Connor, T. P. comparison of two predictive indices Barla, M.; Gavanier, B.; Is amputation a viable 2017 Orthop Traumatol Immediate amputation retrospective, univariate - Mangin, M.; Parot, J.; treatment option in lower Surg Res factors; Patient/Injury very lo quality Bauer, C.; Mainard, D. extremity trauma? factors for LS or Amp Kumar, A.; Mam, M. K.; Ipsilateral fracture of femur and 2006 JK Science Doesn't address question Paul, R. tibia, treatment and functional of interest; outcome Opalic, P.; Lesic, A. Investigation of 2002 Panminerva Med Immediate amputation *Mixed population (lower psychopathological state of factors; Patient/Injury and upper extremities) patients depending on specific factors for LS or Amp clinical characteristics of physical trauma Warkentien, T.; Rodriguez, Invasive mold infections 2012 Clin Infect Dis Patient/Injury factors for LS No controlled comparisons C.; Lloyd, B.; Wells, J.; following combat-related or Amp Weintrob, A.; Dunne, J. R.; injuries Ganesan, A.; Li, P.; Bradley, W.; Gaskins, L. J.; Seillier-Moiseiwitsch, F.; Murray, C. K.; Millar, E. V.; Keenan, B.; Paolino, K.; Fleming, M.; Hospenthal, D. R.; Wortmann, G. W.; Landrum, M. L.; Kortepeter, M. G.; Tribble, D. R. Knaus, J.; Ris, H. B.; Do, D.; Intraoperative catheter 1993 Eur J Vasc Surg Patient/Injury factors for LS Mixed etiology Stirnemann, P. thrombolysis as an adjunct to or Amp surgical revascularisation for infrainguinal limb-threatening ischaemia Evans, J. M.; Gardner, M. Intramedullary fixation of fibular 2010 J Orthop Trauma Patient/Injury factors for LS no comparisons J.; Brennan, M. L.; Phillips, fractures associated with pilon or Amp fractures

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Helfet, D. L.; Koval, K.; Intraarticular "pilon" fracture of 1994 Clin Orthop Relat Res Patient/Injury factors for LS case series; no Pappas, J.; Sanders, R. W.; the tibia or Amp comparisons DiPasquale, T. Tscherne, H.; Regel, G.; Internal fixation of multiple 1998 Clin Orthop Relat Res Immediate amputation *Mixed population (lower Pape, H. C.; Pohlemann, fractures in patients with factors; Patient/Injury and upper extremities) T.; Krettek, C. polytrauma factors for LS or Amp Ostojic, L.; Ostojic, Z.; Intermediate rehabilitation 2001 Croat Med J Patient/Injury factors for LS Doesn't address question Rupcic, E.; Punda-Basic, outcome in below-knee or Amp of interest; M. amputations: descriptive study comparing war-related with other causes of amputation Iqbal, A.; Amin, M. S. Intercalary bone segment 2002 Journal of the Environmental factors for LS No Controlled Comparison transport in treatment of College of Physicians or Amp segmental tibial defects and Surgeons Pakistan KovaÄ쳌, I.; Medved, V.; Instrumented joint mobility 2010 Periodicum Environmental factors for LS no comparison group analysis in traumatic transtibial Biologorum or Amp KasoviÄ?, M.; Heimer, Å½; amputee patients LuÅ¾ar-Stiffler, V.; PeÄ?ina, M. Shin, E.; Evans, K. N.; Injury severity score 2013 J Orthop Trauma Patient/Injury factors for LS prospective univariate; Fleming, M. E. underpredicts injury severity or Amp very low quality and resource utilization in combat-related amputations Korver, A. J. Injuries of the lower limbs 1996 Injury Immediate amputation no controlled comparisons caused by antipersonnel mines: factors the experience of the International Committee of the Red Cross Coupland, R. M.; Korver, Injuries from antipersonnel 1991 Bmj Immediate amputation Mixed population A. mines: the experience of the factors International Committee of the Red Cross

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Soldo, S.; Puntaric, D.; Injuries caused by antipersonnel 1999 Mil Med Immediate amputation Mixed population Petrovicki, Z.; Prgomet, D. mines in Croatian Army soldiers factors on the East Slavonia front during the 1991-1992 war in Croatia Padberg, F. T., Jr.; Infrapopliteal arterial injury: 1992 J Vasc Surg Patient/Injury factors for LS prospective univariate; Rubelowsky, J. J.; prompt revascularization or Amp very low quality Hernandez-Maldonado, J. affords optimal limb salvage J.; Milazzo, V.; Swan, K. G.; Lee, B. C.; Hobson, R. W., 2nd Kamali, M.; Karimi, M. T.; Influential factors in stability of 2013 Am J Phys Med Systematic Reviews References Reviewed Eshraghi, A.; Omar, H. lower-limb amputees Rehabil Ladlow, P.; Phillip, R.; Influence of Immediate and 2016 J Bone Joint Surg Am Immediate amputation Prospective univariate; Coppack, R.; Etherington, Delayed Lower-Limb factors; Patient/Injury very low quality J.; Bilzon, J.; McGuigan, M. Amputation Compared with factors for LS or Amp P.; Bennett, A. N. Lower-Limb Salvage on Functional and Mental Health Outcomes Post-Rehabilitation in the U.K. Military Sharma, G. K.; Dhillon, M. The influence of foot and ankle 2016 Foot (Edinb) Patient/Injury factors for LS no RF of interest S.; Dhatt, S. S. injury patterns and treatment or Amp delays on outcomes in a tertiary hospital; a one-year prospective observation Johnson, E. N.; Burns, T. Infectious complications of open 2007 Clin Infect Dis Patient/Injury factors for LS No RF of interest; C.; Hayda, R. A.; type III tibial fractures among or Amp Hospenthal, D. R.; Murray, combat casualties C. K. Huh, J.; Stinner, D. J.; Infectious complications and 2011 J Trauma Patient/Injury factors for LS no controlled comparison Burns, T. C.; Hsu, J. R. soft tissue injury contribute to or Amp late amputation after severe lower extremity trauma Zalavras, C. G.; Infection following operative 2009 Clin Orthop Relat Res Patient/Injury factors for LS No comparisons Christensen, T.; treatment of ankle fractures or Amp Rigopoulos, N.; Holtom, P.; Patzakis, M. J.

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Yun, H. C.; Murray, C. K.; Infection After Orthopaedic 2016 J Orthop Trauma Systematic Reviews review Nelson, K. J.; Bosse, M. J. Trauma: Prevention and Treatment Jain, A. K.; Sinha, S. Infected nonunion of the long 2005 Clin Orthop Relat Res Immediate amputation Mixed population; bones factors; Patient/Injury factors for LS or Amp Halvachizadeh, S.; Pape, Indications and Decision Making 2018 Current Trauma Immediate amputation Review H. C. in Lower Extremity Reports factors; Patient/Injury Amputations: Has Anything factors for LS or Amp Changed in the Era of Microvascular Soft Tissue and Bone Regeneration Techniques? Ganie, F. A.; Lone, H.; The increasing rate of secondary 2012 Int Cardiovasc Res J Immediate amputation No Controlled Comparison Wani, M. L.; Wani, N. U.; amputation in popliteal arterial factors Ahangar, A. G.; Ganie, S. injury associated with multi- A. organ injuries and hypotension Paula-Ribeiro, M.; Garcia, Increased peripheral vascular 2015 Blood Press Monit Immediate amputation Too few pts M. M.; Martinez, D. G.; resistance in male patients with factors Lima, J. R.; Laterza, M. C. traumatic lower limb amputation: one piece of the cardiovascular risk puzzle Lin, S. H.; Lee, H. Y.; Increased mortality risk for 2010 Am J Epidemiol Immediate amputation mixed etiology Chang, Y. Y.; Jang, Y.; workers with a compensated, factors; Patient/Injury Chen, P. C.; Wang, J. D. permanent occupational factors for LS or Amp disability of the upper or lower extremities: a 21-year follow-up study Gillern, S. M.; Sheppard, F. Incidence of pulmonary 2011 J Trauma Immediate amputation Mixed population; mixed R.; Evans, K. N.; Graybill, J. embolus in combat casualties factors extremity C.; Gage, F. A.; Forsberg, J. with extremity amputations and A.; Dunne, J. R.; Tadaki, D. fractures K.; Elster, E. A. Cross, A. M.; Davis, C.; The incidence of pelvic fractures 2014 J R Nav Med Serv Patient/Injury factors for LS no controlled comparison Penn-Barwell, J.; Taylor, with traumatic lower limb or Amp D. M.; De Mello, W. F.; amputation in modern warfare Matthews, J. J. due to improvised explosive devices 152

Chaloner, E. J. The incidence of landmine 1996 J R Coll Surg Edinb Patient/Injury factors for LS No controlled comparison injuries in Kuito, Angola or Amp Yu, J. C.; Lam, K.; Nettel- Incidence and risk factors of 2010 Pm r Patient/Injury factors for LS wrong population Aguirre, A.; Donald, M.; falling in the postoperative or Amp Dukelow, S. lower limb amputee while on the surgical ward Jupiter, D. C.; Shibuya, N.; Incidence and risk factors for 2012 J Foot Ankle Surg Immediate amputation Amp/Sal as outcome Clawson, L. D.; Davis, M. L. amputation in foot and ankle factors trauma Branco, B. C.; Inaba, K.; Incidence and predictors for the 2011 Injury Immediate amputation mixed extremity Barmparas, G.; need for fasciotomy after factors; Patient/Injury Schnuriger, B.; extremity trauma: a 10-year factors for LS or Amp Lustenberger, T.; Talving, review in a mature level I P.; Lam, L.; Demetriades, trauma centre D. Bevevino, A. J.; Lehman, Incidence and morbidity of 2014 Spine J Patient/Injury factors for LS prospective univariate; R. A., Jr.; Tintle, S. M.; concomitant spine fractures in or Amp very low quality Kang, D. G.; Dworak, T. C.; combat-related amputees Potter, B. K. Fosse, S.; Hartemann- Incidence and characteristics of 2009 Diabet Med Immediate amputation Mixed etiology Heurtier, A.; Jacqueminet, lower limb amputations in factors S.; Ha Van, G.; Grimaldi, people with diabetes A.; Fagot-Campagna, A. Glass, G. E.; Pearse, M. F.; Improving lower limb salvage 2009 J Plast Reconstr Systematic Reviews References Reviewed Nanchahal, J. following fractures with vascular Aesthet Surg injury: a systematic review and new management algorithm Miletta, N. R.; Kim, S.; Improving Health-Related 2016 Dermatol Surg Environmental factors for LS No relevant RFs; no Lezanski-Gujda, A.; Rossi, Quality of Life in Wounded or Amp comparison group A. M.; Marquart, J. D. Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb-Prosthetic Interface Kemp, A. G.; van Niekerk, Impairment scores of type III 1993 Injury Immediate amputation Doesn't address question J. L.; van Meurs, P. A. open tibial fractures factors of interest;

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Ashraf, A.; Shojaee, H.; Impact of pain in vertebral 2012 Disabil Rehabil Patient/Injury factors for LS No controlled comparison Mousavi, B.; Masoumi, column on activities of daily or Amp M.; Rezaei, N.; Azema, H.; living in the Iranian amputees Soroush, M. with bilateral lower limb amputation Dua, A.; Desai, S. S.; The Impact of Geniculate Artery 2016 Ann Vasc Surg Patient/Injury factors for LS no controlled comparison Johnston, S.; Collateral Circulation on Lower or Amp Chinapuvvula, N. R.; Limb Salvage Rates in Injured Wade, C. E.; Fox, C. J.; Patients Holcomb, J. B.; Coogan, S. Woo, S. H.; Kim, J. S.; Seul, Immediate toe-to-hand transfer 2004 Plast Reconstr Surg wrong population; doesn't J. H. in acute hand injuries: overall address question of results, compared with results interest for elective cases Hawkins, B. J.; Langerman, The Ilizarov technique in ankle 1993 Bulletin: Hospital for Immediate amputation Case Series; Mixed R. J.; Anger, D. M.; fusion: A preliminary report Joint Diseases factors Etiology Calhoun, J. H. Hawkins, B. J.; Langerman, The Ilizarov technique in ankle 1994 Clin Orthop Relat Res Immediate amputation Case Series; Mixed R. J.; Anger, D. M.; fusion factors Etiology Calhoun, J. H. Woodman, G.; Croce, M. Iliac artery ischemic: analysis of 1998 Am Surg Immediate amputation No controlled comparison A.; Fabian, T. C. risks for ischemic complications factors Cestero, R. F.; Plurad, D.; Iliac artery injuries and pelvic 2009 J Trauma Immediate amputation wrong population; pelvic Green, D.; Inaba, K.; Putty, fractures: a national trauma factors injury B.; Benfield, R.; Lam, L.; database analysis of associated Talving, P.; Demetriades, injuries and outcomes D. Marchaland, J. P.; Ollat, How to Cover Soft-Tissue 2009 Eur J Trauma Emerg Immediate amputation Case Series D.; Mathieu, L.; Versier, G. Defects After Injuries to the Leg Surg factors; Patient/Injury in Precarious Conditions factors for LS or Amp Russell Esposito, E.; How does ankle-foot orthosis 2014 Clin Orthop Relat Res Environmental factors for LS No Controlled Comparison Blanck, R. V.; Harper, N. stiffness affect gait in patients or Amp G.; Hsu, J. R.; Wilken, J. M. with lower limb salvage? Wagels, M.; Rowe, D.; History of lower limb 2013 ANZ Journal of Systematic Reviews References Reviewed Senewiratne, S.; Theile, D. reconstruction after trauma Surgery R.

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Bible, J. E.; High-energy transsyndesmotic 2014 Journal of Patient/Injury factors for LS No comparisons Sivasubramaniam, P. G.; ankle fracture dislocation - The Orthopaedic Trauma or Amp Jahangir, A. A.; Evans, J. "logsplitter" injury M.; Mir, H. R. French, B.; Tornetta, Iii P. High-energy tibial shaft 2002 Orthopedic Clinics of Patient/Injury factors for LS Review fractures North America or Amp Tejwani, N. C.; Hak, D. J.; High-energy proximal tibial 2006 Instr Course Lect Patient/Injury factors for LS Review Finkemeier, C. G.; fractures: treatment options or Amp Wolinsky, P. R. and decision making Wascher, D. C. High-energy knee dislocations 2003 Operative Patient/Injury factors for LS Review Techniques in Sports or Amp Medicine Tarkin, I. S.; Sop, A.; Pape, High-energy foot and ankle 2008 Foot Ankle Clin Systematic Reviews review H. C. trauma: principles for formulating an individualized care plan Anderson, L. A.; Culp, B. High Failure Rates of 2018 Journal of Patient/Injury factors for LS No high-energy; M.; Della Valle, C. J.; Concomitant Periprosthetic Arthroplasty or Amp Gililland, J. M.; Joint Infection and Extensor Meneghini, R. M.; Mechanism Disruption Browne, J. A.; Springer, B. D. Dickson, K. F.; High energy plafond fractures 2001 Injury Patient/Injury factors for LS No comparisons Montgomery, S.; Field, J. treated by a spanning external or Amp fixator initially and followed by a second stage open reduction internal fixation of the articular surface--preliminary report Napora, J. K.; Weinberg, Hexapod Stacked Transport for 2018 J Orthop Trauma Patient/Injury factors for LS univariate - mean dif; not D. S.; Eagle, B. A.; Tibial Infected Nonunions With or Amp best available Kaufman, B. R.; Sontich, J. Bone Loss: Long-Term K. Functional Outcomes Napora, J. K.; Weinberg, Hexapod Frame Stacked 2017 J Orthop Trauma Patient/Injury factors for LS retrospective, univariate - D. S.; Eagle, B. A.; Transport for Tibial Infected or Amp very low quality Kaufman, B. R.; Sontich, J. Nonunions With Bone Loss: K. Analysis of Use of Adjunctive Stability

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Talbot, L. A.; Brede, E.; Health-related quality of life in 2017 Nurs Outlook Patient/Injury factors for LS No RF of interest Price, M.; Metter, E. J. active duty military: A or Amp secondary data analysis of two randomized controlled trials MacKenzie, E. J.; Jones, A. Health-care costs associated 2007 J Bone Joint Surg Am Cost Analysis S.; Bosse, M. J.; Castillo, R. with amputation or C.; Pollak, A. N.; Webb, L. reconstruction of a limb- X.; Swiontkowski, M. F.; threatening injury Kellam, J. F.; Smith, D. G.; Sanders, R. W.; Jones, A. L.; Starr, A. J.; McAndrew, M. P.; Patterson, B. M.; Burgess, A. R. Thakore, R. V.; Francois, E. The Gustilo-Anderson 2017 Eur J Trauma Emerg Immediate amputation unclear population; L.; Nwosu, S. K.; Attum, B.; classification system as Surg factors unclear if all high energy Whiting, P. S.; Siuta, M. predictor of nonunion and A.; Benvenuti, M. A.; infection in open tibia fractures Smith, A. K.; Shen, M. S.; Mousavi, I.; Obremskey, W. T.; Sethi, M. K. Tunali, O.; Saglam, Y.; Gustilo type IIIC open tibia 2017 Eur J Trauma Emerg Immediate amputation No controlled comparison Balci, H. I.; Kochai, A.; fractures with vascular repair: Surg factors; Patient/Injury Sahbaz, N. A.; Sayin, O. A.; minimum 2-year follow-up factors for LS or Amp Yazicioglu, O. Grossman, M. D.; Reilly, Gunshot wounds below the 1999 Am Surg Patient/Injury factors for LS case series; no P.; McMahan, D.; Kauder, popliteal fossa: a contemporary or Amp comparisons; no D.; Schwab, C. W. review controlled comparisons Hoogendoorn, J. M.; van Grade III open tibial fractures: 2001 Injury Patient/Injury factors for LS prospective univariate; der Werken, C. functional outcome and quality or Amp very low quality of life in amputees versus patients with successful reconstruction Balci, H. I.; Saglam, Y.; Grade 3C open femur fractures 2015 Acta Orthop Belg Immediate amputation No controlled comparison Tunali, O.; Akgul, T.; with vascular repair in adults factors; Patient/Injury Aksoy, M.; Dikici, F. factors for LS or Amp

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Rajasekaran, S.; Ganga hospital open injury 2015 Eur J Trauma Emerg Patient/Injury factors for LS Commentary Sabapathy, S. R.; score in management of open Surg or Amp Dheenadhayalan, J.; injuries Sundararajan, S. R.; Venkatramani, H.; Devendra, A.; Ramesh, P.; Srikanth, K. P. Archer, K. R.; Castillo, R. Gait symmetry and walking 2006 Phys Ther Patient/Injury factors for LS Amputation/Salvage as C.; Mackenzie, E. J.; Bosse, speed analysis following lower- or Amp; Environmental Outcome M. J. extremity trauma factors for LS or Amp Russell Esposito, E.; Gait biomechanics following 2017 Gait Posture Environmental factors for LS univariate - mean dif; not Stinner, D. J.; Fergason, J. lower extremity trauma: or Amp best available R.; Wilken, J. M. Amputation vs. reconstruction Mahon, C. E.; Pruziner, A. Gait and Functional Outcomes 2017 Mil Med Patient/Injury factors for LS No controlled comparison L.; Hendershot, B. D.; for Young, Active Males With or Amp Wolf, E. J.; Darter, B. J.; Traumatic Unilateral Foreman, K. B.; Webster, Transfemoral Limb Loss J. B. Bonanni, F.; Rhodes, M.; The futility of predictive scoring 1993 J Trauma Patient/Injury factors for LS no controlled comparison; Lucke, J. F. of mangled lower extremities or Amp retrospective data; very low quality; Parmaksizoglu, F.; Unal, Functional results of limb 2012 J Reconstr Microsurg Immediate amputation case series M. B.; Cansu, E.; Koprulu, salvage in below-knee type III C factors A. S.; Ince, Y.; Yurga, E. open fractures or traumatic amputations Barker, K. L.; Lamb, S. E.; Functional recovery in patients 2004 J Bone Joint Surg Br Patient/Injury factors for LS No comparison group Simpson, A. H. with nonunion treated with the or Amp Ilizarov technique Rodriguez, E. D.; Functional outcomes of 2009 J Trauma Patient/Injury factors for LS No RF of interest; Bluebond-Langner, R.; posttraumatic lower limb or Amp Copeland, C.; Grim, T. N.; salvage: a pilot study of Singh, N. K.; Scalea, T. anterolateral thigh perforator flaps versus muscle flaps Gopal, S.; Giannoudis, P. The functional outcome of 2004 J Bone Joint Surg Br Patient/Injury factors for LS prospective univariate; V.; Murray, A.; Matthews, severe, open tibial fractures or Amp very low quality S. J.; Smith, R. M.

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Lin, C. H.; Wei, F. C.; Levin, The functional outcome of 1997 J Trauma Immediate amputation not best available; very L. S.; Su, J. I.; Yeh, W. L. lower-extremity fractures with factors; Patient/Injury low quality vascular injury factors for LS or Amp Smith, J. J.; Agel, J.; Functional outcome of bilateral 2005 J Orthop Trauma Patient/Injury factors for LS No controlled comparison Swiontkowski, M. F.; limb threatening: lower or Amp Castillo, R.; Mackenzie, E.; extremity injuries at two years Kellam, J. F. postinjury Dahl, B.; Andersson, A. P.; Functional and social long-term 1995 Ann Plast Surg Patient/Injury factors for LS Mixed etiology; no Andersen, M.; Andersen, results after free tissue transfer or Amp controlled comparison G. R.; Ebskov, L. B.; to the lower extremity Reumert, T. van der Merwe, L.; Functional and psychological 2016 Injury Patient/Injury factors for LS No Controlled Comparison Birkholtz, F.; Tetsworth, outcomes of delayed lower limb or Amp; Environmental K.; Hohmann, E. amputation following failed factors for LS or Amp lower limb reconstruction Fairhurst, M. J. The function of below-knee 1994 Clin Orthop Relat Res Environmental factors for LS No Controlled Comparison amputee versus the patient with or Amp salvaged grade III tibial fracture Ikram, M.; Iqbal, A.; Ayaz, Frequency and socio- 2014 Rawal Medical Patient/Injury factors for LS mixed etiology S. B.; Gill, Z. A.; Matee, S. demographic predictors of Journal or Amp clinical depression in combat amputees at a military rehabilitation setup Lundy, J. B.; Oh, J. S.; Frequency and relevance of 2013 J Trauma Acute Care Patient/Injury factors for LS mixed extremity Chung, K. K.; Ritter, J. L.; acute peritraumatic pulmonary Surg or Amp Gibb, I.; Nordmann, G. R.; thrombus diagnosed by Sonka, B. J.; Tai, N. R.; computed tomographic imaging Aden, J. K.; Rasmussen, T. in combat casualties E. Ahmad, S.; Siddique, O. Frequency and presentation of 2017 Medical Forum Patient/Injury factors for LS Incorrect pts population; M.; Ikram, N.; Hamid, K. wheel spoke injury of heel at Monthly or Amp no controlled comparison plastic surgery department of allama iqbal memorial teaching hospital, sialkot 158

Hammert, W. C.; Free-flap reconstruction of 2000 Am J Orthop (Belle Environmental factors for LS No controlled comparison; Minarchek, J.; Trzeciak, M. traumatic lower extremity Mead NJ) or Amp No relevant RFs A. wounds Wink, J. D.; Nelson, J. A.; Free tissue transfer for complex 2014 J Reconstr Microsurg Immediate amputation mixed etiology Fischer, J. P.; Cleveland, E. reconstruction of the lower factors C.; Kovach, S. J., 3rd extremity: experience of a young microsurgeon Baumann, D. P.; Chang, D. Free Flap Reconstruction for 2009 Techniques in Patient/Injury factors for LS Review W. Complex Lower Extremity Orthopaedics or Amp Wounds Cleveland, E. C.; Fischer, J. Free flap lower extremity 2014 Journal of Patient/Injury factors for LS Mixed etiology; no P.; Nelson, J. A.; Wink, J. reconstruction in the obese Reconstructive or Amp controlled comparison D.; Levin, L. S.; Kovach, S. population: Does weight Microsurgery J. matter? Wei, F. C.; El-Gammal, T. Free fibula 1997 Journal of Trauma - Patient/Injury factors for LS No relevant RFs; No A.; Lin, C. H.; Ueng, W. N. osteoseptocutaneous graft for Injury, Infection and or Amp comparison group reconstruction of segmental Critical Care femoral shaft defects Houdek, M. T.; Wagner, E. Free Composite Serratus 2018 Am J Orthop (Belle Patient/Injury factors for LS Too few pts R.; Watts, C. D.; Sems, S. Anterior-Latissimus-Rib Flaps for Mead NJ) or Amp A.; Moran, S. L. Acute One-Stage Reconstruction of Gustilo IIIB Tibia Fractures Aho, J. M.; Sen, M. K.; Free and pedicle flaps in lower 2015 European Journal of Systematic Reviews review Saint-Cyr, M. extremity trauma Plastic Surgery Paul, G. R.; Sawka, M. W.; Fractures of the ipsilateral 1990 J Orthop Trauma Patient/Injury factors for LS case series; no Whitelaw, G. P. femur and tibia: emphasis on or Amp comparisons of interest intra-articular and soft tissue injury Richter, M.; Wippermann, Fractures and fracture 2001 Foot Ankle Int Patient/Injury factors for LS mixed etiology; no B.; Krettek, C.; Schratt, H. dislocations of the midfoot: or Amp relevant RFs E.; Hufner, T.; Therman, H. occurrence, causes and long- term results Brinker, M. R.; Bailey, D. Fracture healing in tibia 1997 J Trauma Patient/Injury factors for LS not best available; very E., Jr. fractures with an associated or Amp low quality vascular injury

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Andersen, R. C.; Fracture care about the knee in 2010 Techniques in Knee Systematic Reviews review; case review; Pressman, D. N.; Keeling, high-energy war injuries Surgery J. J.; Gordon, W. Parrett, B. M.; Pomahac, Fourth-degree burns to the 2006 J Burn Care Res Patient/Injury factors for LS No high-energy trauma B.; Demling, R. H.; Orgill, lower extremity with exposed or Amp D. P. tendon and bone: a ten-year experience Thiagarajan, P.; Neeta, S.; Forklift related injuries 1998 Journal of Patient/Injury factors for LS No relevant RFs Das De, S. Orthopaedic Surgery or Amp McGuigan, F. X.; Forsberg, Foot and ankle reconstruction 2006 Foot Ankle Clin Systematic Reviews review J. A.; Andersen, R. C. after blast injuries Lundy, D. W.; Johnson, K. "Floating knee" injuries: 2001 J Am Acad Orthop Systematic Reviews review D. ipsilateral fractures of the femur Surg and tibia DiChristina, D. G.; Riemer, Femur fractures with femoral or 1994 J Orthop Trauma Patient/Injury factors for LS No comparison group B. L.; Butterfield, S. L.; popliteal artery injuries in blunt or Amp Burke, C. J., 3rd; Herron, trauma M. K.; Phillips, D. J. UÇ§ur, O.; KarakaÅ?, A. O. Femoral artery injuries due to 2017 Turkiye Klinikleri Immediate amputation Case Series gunshot injury in Somalia Cardiovascular factors civilwar continues Sciences Bartle, D.; Keating, J. Femoral and tibial fractures 2013 Surgery (United Systematic Reviews review Kingdom) Pinzur, M. S.; Angelico, J. A feasibility trial of a 2003 Foot Ankle Int Immediate amputation mixed etiology prefabricated immediate factors postoperative prosthetic limb system Culliford, A. T. th; Spector, The fate of lower extremities 2007 Ann Plast Surg Patient/Injury factors for LS Mixed etiology J.; Blank, A.; Karp, N. S.; with failed free flaps: a single or Amp Kasabian, A.; Levine, J. P. institution's experience over 25 years Beltran, M. J.; Burns, T. C.; Fate of combat nerve injury 2012 J Orthop Trauma Patient/Injury factors for LS no relevant outcome data Eckel, T. T.; Potter, B. K.; or Amp Wenke, J. C.; Hsu, J. R.

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Ramasamy, M. A.; Hill, A. FASS is a better predictor of 2013 J Orthop Trauma Patient/Injury factors for LS No controlled comparisons M.; Phillip, R.; Gibb, I.; poor outcome in lower limb or Amp ; very low quality Bull, A. M.; Clasper, J. C. blast injury than AIS: implications for blast research MacKenzie, E. J.; Bosse, Factors influencing the decision 2002 J Trauma Immediate amputation Amputation/Salvage as M. J.; Kellam, J. F.; to amputate or reconstruct after factors; Patient/Injury Outcome Burgess, A. R.; Webb, L. high-energy lower extremity factors for LS or Amp; X.; Swiontkowski, M. F.; trauma Environmental factors for LS Sanders, R.; Jones, A. L.; or Amp McAndrew, M. P.; Patterson, B.; McCarthy, M. L.; Rohde, C. A. MacKenzie, E. J.; Bosse, Factors influencing outcome 2006 J Am Acad Orthop Systematic Reviews review M. J. following limb-threatening Surg lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP) Penn-Barwell, J. G.; Factors influencing infection in 2016 Strategies Trauma Patient/Injury factors for LS prospective univariate; Bennett, P. M.; Mortiboy, 10 years of battlefield open tibia Limb Reconstr or Amp very low quality D. E.; Fries, C. A.; Groom, fractures A. F.; Sargeant, I. D. van der Vliet, Q. M. J.; Factors Influencing Functional 2018 Foot Ankle Int Patient/Injury factors for LS Mixed etiology Hietbrink, F.; Casari, F.; Outcomes of Subtalar Fusion for or Amp Leenen, L. P. H.; Heng, M. Posttraumatic Arthritis After Calcaneal Fracture Manley, N. R.; Magnotti, Factors Contributing to 2018 Am Surg Immediate amputation No RF of interest L. J.; Fabian, T. C.; Morbidity after Combined factors Cutshall, M. B.; Croce, M. Arterial and Venous Lower A.; Sharpe, J. P. Extremity Trauma Kurichi, J. E.; Ripley, D. C.; Factors Associated With Home 2013 PM and R Environmental factors for LS mixed etiology Xie, D.; Kwong, P. L.; Discharge After Rehabilitation or Amp Bates, B. E.; Stineman, M. Among Male Veterans With G. Lower Extremity Amputation Perkins, Z. B.; De'Ath, H. Factors affecting outcome after 2012 Br J Surg Systematic Reviews References Reviewed D.; Sharp, G.; Tai, N. R. traumatic limb amputation

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Guraya, S. Y. Extremity vascular trauma in 2004 Saudi Med J Patient/Injury factors for LS No controlled comparisons Pakistan or Amp Menakuru, S. R.; Behera, Extremity vascular trauma in 2005 Injury Immediate amputation mixed extremity A.; Jindal, R.; Kaman, L.; civilian population: a seven-year factors; Patient/Injury Doley, R.; Venkatesan, R. review from North India factors for LS or Amp

Wiss, D. A.; Sherman, R.; External skeletal fixation and 1993 Orthop Clin North case series Oechsel, M. rectus abdominis free-tissue Am transfer in the management of severe open fractures of the tibia Bedes, L.; Bonnevialle, P.; External fixation of distal 2014 Orthop Traumatol Patient/Injury factors for LS no RF of interest Ehlinger, M.; Bertin, R.; femoral fractures in adults' Surg Res or Amp Vandenbusch, E.; Pietu, G. multicentre retrospective study of 43 patients Livingston, D. H.; Keenan, Extent of disability following 1994 J Trauma Mixed extremity D.; Kim, D.; Elcavage, J.; traumatic extremity amputation Malangoni, M. A. Hashmi, P. M. An experience with free 2004 J Ayub Med Coll Patient/Injury factors for LS No controlled comparison scapular flap for reconstruction Abbottabad or Amp of lower extremity defects at Aga Khan University Hospital Karachi Clover, A. J.; Rannan-Eliya, Experience of an orthoplastic 2011 Plast Reconstr Surg Patient/Injury factors for LS No controlled comparison S.; Saeed, W.; Buxton, R.; limb salvage team after the Haiti or Amp Majumder, S.; earthquake: analysis of caseload Hettiaratchy, S. P.; Jemec, and early outcomes B. Hallock, G. G. Evidence-based medicine: lower 2013 Plast Reconstr Surg Systematic Reviews review extremity acute trauma Sheean, A. J.; Krueger, C. Evaluation of the mangled 2014 J Orthop Trauma Immediate amputation SENS/SPEC data; A.; Napierala, M. A.; extremity severity score in factors Retro/Uni; very low quality Stinner, D. J.; Hsu, J. R. combat-related type III open tibia fracture

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Ozturk, S.; Bayram, Y.; Evaluation of late functional 2005 Plast Reconstr Surg Patient/Injury factors for LS No relevant RFs; no Mohur, H.; Deveci, M.; results of patients treated with or Amp; Environmental comparison group Sengezer, M. free muscle flaps for heel factors for LS or Amp defects caused by land-mine explosions Tanga, C.; Franz, R.; Hill, J.; Evaluation of Experience with 2018 Int J Angiol Patient/Injury factors for LS Mixed etiology Lieber, M.; Galante, J. Lower Extremity Arterial Injuries or Amp at an Urban Trauma Center Ebrahimzadeh, M. H.; Evaluation of disabilities and 2016 Prosthet Orthot Int Immediate amputation No comparison of interest Moradi, A.; Bozorgnia, S.; activities of daily living of war- factors; Patient/Injury Hallaj-Moghaddam, M. related bilateral lower extremity factors for LS or Amp amputees Guner, S. I.; Oncu, M. R. Evaluation of crush syndrome 2014 J Clin Nurs Immediate amputation No controlled comparison patients with extremity injuries factors in the 2011 Van Earthquake in Turkey Lawrence, S. J.; Grau, G. F. Evaluation and treatment of 2003 Orthopedics Immediate amputation case series open calcaneal fractures: a factors retrospective analysis

Ziegler-Graham, K.; Estimating the prevalence of 2008 Arch Phys Med Doesn't address question MacKenzie, E. J.; Ephraim, limb loss in the United States: Rehabil of interest; P. L.; Travison, T. G.; 2005 to 2050 Brookmeyer, R. Barmparas, G.; Inaba, K.; Epidemiology of post-traumatic 2010 Am Surg Immediate amputation mixed extremity; upper Teixeira, P. G.; Dubose, J. limb amputation: a National factors and lower limbs J.; Criscuoli, M.; Talving, Trauma Databank analysis P.; Plurad, D.; Green, D.; Demetriades, D. Gopinathan, N. R.; Epidemiology of lower limb 2017 Indian J Orthop Immediate amputation very low quality Santhanam, S. S.; Saibaba, musculoskeletal trauma with factors B.; Dhillon, M. S. associated vascular injuries in a tertiary care institute in India Bachier, M.; Feliz, A. Epidemiology of lawnmower- 2016 American Journal of Patient/Injury factors for LS *mixed-upper & lower related injuries in children: A 10- Surgery or Amp extremity* year review

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Ghazisaidi, M. R.; End-to-side anastomosis for 2010 Ulus Travma Acil Patient/Injury factors for LS No relevant RFs Mozafari, N.; Yavari, M.; limb salvage in the single artery Cerrahi Derg or Amp Hosseini, S. N. of a traumatized extremity Crawford, B.; Watson, J. End-stage hindfoot arthrosis: 2014 J Foot Ankle Surg Patient/Injury factors for LS Mixed etiology T.; Jackman, J.; Fissel, B.; outcomes of tibiocalcaneal or Amp Karges, D. E. fusion using internal and Ilizarov fixation Biagioni, R. B.; Burihan, Endovascular treatment of 2018 Vasa Patient/Injury factors for LS Mixed population; mixed M. C.; Nasser, F.; Biagioni, penetrating arterial trauma with or Amp etiology L. C.; Ingrund, J. C. stent grafts Piffaretti, G.; Tozzi, M.; Endovascular treatment for 2007 Injury Patient/Injury factors for LS Mixed population Lomazzi, C.; Rivolta, N.; traumatic injuries of the or Amp Caronno, R.; Lagana, D.; peripheral arteries following Carrafiello, G.; Castelli, P. blunt trauma Yang, R. S. Endoprosthesis-related 2004 Biomedical Systematic Reviews review complications after limb-salvage Engineering - operation of malignant bone Applications, Basis tumors around the knee and Communications Talbot, L. A.; Brede, E.; Effects of Adding 2017 Mil Med Environmental factors for LS Doesn't answer question Metter, E. J. Neuromuscular Electrical or Amp of interest Stimulation to Traditional Military Amputee Rehabilitation Rauh, M. J.; Aralis, H. J.; Effect of traumatic brain injury 2013 J Rehabil Res Dev Patient/Injury factors for LS mixed extremity Melcer, T.; Macera, C. A.; among U.S. servicemembers or Amp; Environmental Sessoms, P.; Bartlett, J.; with amputation factors for LS or Amp Galarneau, M. R. Yeh, H. K.; Fang, F.; Lin, Y. The effect of systemic injury 2016 Injury Immediate amputation Amp/Sal as outcome; T.; Lin, C. H.; Lin, C. H.; score on the decision making of factors retrospective univariate Hsu, C. C. mangled lower extremities Chua, W.; De, S. D.; Lin, Early versus late flap coverage 2014 J Orthop Surg (Hong Patient/Injury factors for LS No relevant RFs W. K.; Kagda, F.; Murphy, for open tibial fractures Kong) or Amp D. Williams, Z. F.; Bools, L. Early versus delayed amputation 2015 Am Surg Immediate amputation No controlled comparison M.; Adams, A.; Clancy, T. in the setting of severe lower factors V.; Hope, W. W. extremity trauma

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Ebrahimi, A.; Early Reconstructions of 2017 World J Plast Surg Patient/Injury factors for LS No controlled Nejadsarvari, N.; Complex Lower Extremity or Amp comparisons; Case-series Ebrahimi, A.; Rasouli, H. R. Battlefield Soft Tissue Wounds Christy, M. R.; Lipschitz, Early postoperative outcomes 2014 Ann Plast Surg Immediate amputation No controlled comparison A.; Rodriguez, E.; Chopra, associated with the factors; Patient/Injury K.; Yuan, N. anterolateral thigh flap in factors for LS or Amp Gustilo IIIB fractures of the lower extremity Parmaksizoglu, F.; Early or delayed limb 2010 J Bone Joint Surg Br Environmental factors for LS No Controlled Comparison Koprulu, A. S.; Unal, M. B.; lengthening after acute or Amp Cansu, E. shortening in the treatment of traumatic below-knee amputations and Gustilo and Anderson type IIIC open tibial fractures: The results of a case series Conroy, J.; Agarwal, M.; Early internal fixation and soft 2003 Int Orthop No usable data; statistical Giannoudis, P. V.; tissue cover of severe open comparisons not of Matthews, S. J. tibial pilon fractures interest Farber, A.; Tan, T. W.; Early fasciotomy in patients with 2012 Injury Patient/Injury factors for LS Amputation/Salvage as Hamburg, N. M.; Kalish, J. extremity vascular injury is or Amp Outcome A.; Joglar, F.; Onigman, T.; associated with decreased risk Rybin, D.; Doros, G.; of adverse limb outcomes: a Eberhardt, R. T. review of the National Trauma Data Bank Xu, Y. Q.; Li, Q.; Shen, T. Early diagnosis and treatment of 2015 Int J Clin Exp Med Cost Analysis G.; Su, P. H.; Zhu, Y. Z. trauma in knee joints accompanied with popliteal vascular injury Esposito, E. R.; Rodriguez, Does unilateral transtibial 2014 J Rehabil Res Dev Patient/Injury factors for LS no RF of interest K. M.; Rabago, C. A.; amputation lead to greater or Amp Wilken, J. M. metabolic demand during walking? Burns, T. C.; Stinner, D. J.; Does the zone of injury in 2010 J Orthop Trauma Patient/Injury factors for LS No RF of interest Possley, D. R.; Mack, A. combat-related Type III open or Amp W.; Eckel, T. T.; Potter, B. tibia fractures preclude the use K.; Wenke, J. C.; Hsu, J. R. of local soft tissue coverage?

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Pruziner, A. L.; Werner, K. Does intact limb loading differ in 2014 Clin Orthop Relat Res Environmental factors for LS No Controlled Comparison M.; Copple, T. J.; servicemembers with traumatic or Amp Hendershot, B. D.; Wolf, E. lower limb loss? J. Guirao, L.; Samitier, B.; Distance and speed of walking 2018 Orthop Traumatol Environmental factors for LS Mixed Etiology Tibau, R.; Alos, J.; in individuals with trans-femoral Surg Res or Amp Monago, M.; Morales- amputation fitted with a distal Suarez-Varela, M.; weight-bearing implant Pleguezuelos, E. Lietman, S. A.; Inoue, N.; Distal femoral osteoarticular 1999 Ann Chir Gynaecol wrong population; tumors Chao, E. Y.; Frassica, F. J. allografts in limb salvage surgery Andersen, R. C.; Fleming, Dismounted Complex Blast 2012 J Surg Orthop Adv review M.; Forsberg, J. A.; Injury Gordon, W. T.; Nanos, G. P.; Charlton, M. T.; Ficke, J. R. Couto, R. A.; Gurunluoglu, Discussion: An Argument for 2015 Plastic and Systematic Reviews Systematic review R. Salvage in Severe Lower reconstructive Extremity Trauma with Posterior surgery Tibial Nerve Injury: The Ganga Hospital Experience Highsmith, M. J.; Kahle, J. Differences in Military Obstacle 2016 Mil Med Environmental factors for LS Mixed Etiology T.; Miro, R. M.; Lura, D. J.; Course Performance Between or Amp Carey, S. L.; Wernke, M. Three Energy-Storing and Shock- M.; Kim, S. H.; Quillen, W. Adapting Prosthetic Feet in S. High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial Modrall, J. G.; Weaver, F. Diagnosis and management of 1998 Emerg Med Clin Systematic Reviews review A.; Yellin, A. E. penetrating vascular trauma North Am and the injured extremity Keyser, J. E. Diabetic wound healing and 1993 South Med J Patient/Injury factors for LS Unclear trauma; limb salvage in an outpatient or Amp wound care program

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Maclean, A. A.; O'Neill, A. Devastating consequences of 2006 Am Surg case series; no M.; Pachter, H. L.; subway accidents: traumatic comparisons of interest Miglietta, M. A. amputations Katzman, S. S.; Dickson, K. Determining the prognosis for 1992 Orthop Rev Immediate amputation <20 patients; 19 subjects limb salvage in major vascular factors injuries with associated open tibial fractures Ramanan, B.; Ahmed, A.; Determinants of midterm 2017 J Vasc Surg Immediate amputation Non-trauma patients Wu, B.; Causey, M. W.; functional outcomes, wound factors; Patient/Injury Gasper, W. J.; Vartanian, healing, and resources used in a factors for LS or Amp S. M.; Reyzelman, A. M.; hospital-based limb Hiramoto, J. S.; Conte, M. preservation program S. Rotter, K.; Sanhueza, R.; A descriptive study of traumatic 2006 Prosthet Orthot Int case series; no Robles, K.; Godoy, M. lower limb amputees from the comparisons of interest Hospital Hel Trabajador: clinical evolution from the accident until rehabilitation discharge Hill, O.; Bulathsinhala, L.; Descriptive Characteristics and 2016 Mil Med Environmental factors for LS No Controlled Comparison Eskridge, S. L.; Quinn, K.; Amputation Rates With Use of or Amp Stinner, D. J. Intrepid Dynamic Exoskeleton Orthosis Patzkowski, J. C.; Owens, Deployment after limb salvage 2012 J Trauma Acute Care Environmental factors for LS No Controlled Comparison J. G.; Blanck, R. V.; Kirk, K. for high-energy lower-extremity Surg or Amp L.; Hsu, J. R. trauma Sohn, V. Y.; Arthurs, Z. M.; Demographics, treatment, and 2008 Arch Surg Patient/Injury factors for LS *mixed-upper & lower Herbert, G. S.; Beekley, A. early outcomes in penetrating or Amp extremity* C.; Sebesta, J. A. vascular combat trauma Rathore, F. A.; Ayaz, S. B.; Demographics of Lower Limb 2016 Cureus Patient/Injury factors for LS No comparison group; No Mansoor, S. N.; Qureshi, Amputations in the Pakistan or Amp relevant RFs A. R.; Fahim, M. Military: A Single Center, Three- Year Prospective Survey Cannada, L. K.; Jones, A. L. Demographic, social and 2006 Injury Patient/Injury factors for LS No comparison group economic variables that affect or Amp; Environmental lower extremity injury factors for LS or Amp outcomes

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Thiagarajan, P. Delayed amputation in lower 1999 Ann Acad Med Immediate amputation Mixed etiology; no limb trauma: an analysis of Singapore factors controlled comparison factors leading to delayed amputation Yokoyama, K.; Itoman, M.; Deep infection and fracture 1999 Orthopedics Patient/Injury factors for LS Population n<10; no Shindo, M.; Kai, H.; Ueta, healing in immediate and or Amp relevant RFs S.; Kobayashi, A. delayed locked intramedullary nailing for open femoral fractures Grigorian, A.; Wilson, S. Decreased National Rate of 2018 Ann Vasc Surg Patient/Injury factors for LS Amputation/Salvage as E.; Kabutey, N. K.; Fujitani, below the Knee Amputation in or Amp Outcome R. M.; de Virgilio, C.; Patients with Popliteal Artery Schubl, S. D.; Gabriel, V.; Injury Chen, S.; Joe, V.; Nahmias, J. Krajewski, A.; Decision making in limb salvage: 2012 Techniques in Patient/Injury factors for LS Commentary; no usable Chandawarkar, R. Y. A challenge for the orthoplastic Orthopaedics or Amp data team Hierner, R.; Betz, A. M.; Decision making and results in 1995 Microsurgery Immediate amputation Case Series Comtet, J. J.; Berger, A. C. subtotal and total lower leg factors amputations: reconstruction versus amputation Subramanian, A.; A decade's experience with 2008 J Trauma Patient/Injury factors for LS No Controlled Vercruysse, G.; Dente, C.; temporary intravascular shunts or Amp Comparison; Mixed Wyrzykowski, A.; King, E.; at a civilian level I trauma center population Feliciano, D. V. Ramdass, M. J.; A decade of major vascular 2017 Ann R Coll Surg Engl Immediate amputation Mixed Etiology Harnarayan, P. trauma: Lessons learned from factors gang and civilian warfare Jaha, L.; Andreevska, T.; A decade of civilian vascular 2012 World J Emerg Surg Patient/Injury factors for LS Mixed extremity Rudari, H.; Ademi, B.; trauma in Kosovo or Amp Ismaili-Jaha, V. Hurvitz, G.; Zalavras, C.; Debridement and primary 2004 Am J Orthop (Belle Patient/Injury factors for LS No Controlled Thordarson, D. B. closure of nonhealing foot Mead NJ) or Amp Comparison; Incorrect wounds patient population

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Gasser, B.; Tiefenboeck, T. Damage control surgery - 2017 BMC Environmental factors for LS prospective univariate; M.; Boesmueller, S.; Experiences from a level i Musculoskeletal or Amp very low quality Kivaranovic, D.; Bukaty, trauma center Disorders A.; Platzer, P. Mathieu, L.; Marty, A.; Current issues with lower 2014 Eur J Trauma Emerg Immediate amputation No comparison of interest Ramaki, A.; Najib, A.; extremity amputations in a Surg factors Ahmadzai, W.; Fugazzotto, country at war: experience from D. J.; Rigal, S.; Shirzai, N. the National Military Hospital of Kabul Desmond, E. A.; Chou, L. Current concepts review: 2006 Foot and Ankle Systematic Reviews review B. Lisfranc injuries International Ofer, N.; Baumeister, S.; Current concepts of 2007 J Plast Reconstr Patient/Injury factors for LS Mixed extremity Megerle, K.; Germann, G.; microvascular reconstruction for Aesthet Surg or Amp Sauerbier, M. limb salvage in electrical burn injuries Williams, T. K.; Clouse, W. Current concepts in repair of 2016 J Vasc Surg Venous Systematic Reviews review D. extremity venous injury Lymphat Disord Edelstein, D. A.; Florescu, Crushing injuries of the foot and 2016 J Med Life Patient/Injury factors for LS Population n<10 I. ankle, with complex open or Amp fractures: result of a prospective study with a 3 year follow-up Demirkiran, O.; Dikmen, Crush syndrome patients after 2003 Emerg Med J Patient/Injury factors for LS No controlled comparison; Y.; Utku, T.; Urkmez, S. the Marmara earthquake or Amp No relevant RFs; Mixed population; Sharma, S.; Devgan, A.; Critical evaluation of mangled 2003 Injury Immediate amputation No Controlled Comparison Marya, K. M.; Rathee, N. extremity severity scoring factors system in Indian patients Khan, M. A.; Jamal, S.; A critical appraisal of 2011 Rawal Medical Immediate amputation mixed extremity Khaliq, T. management of extremity Journal factors vascular trauma in civilian population: A PIMS experience Clarke, P.; Mollan, R. A. The criteria for amputation in 1994 Injury Systematic Reviews Systematic review severe lower limb injury

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Horch, R. E.; Dragu, A.; Coverage of exposed bones and 2008 Journal of Cutaneous unclear etiology; no Lang, W.; Banwell, P.; joints in critically ill patients: Medicine and comparisons of interest; Leffler, M.; Grimm, A.; Lower extremity salvage with Surgery Bach, A. D.; Uder, M.; topical negative pressure Kneser, U. therapy Ceballos, M.; Valderrama, Cost-Utility Analysis of 2017 J Orthop Trauma Cost Analysis C. O.; Orozco, L. E.; Reconstruction Compared With Sanchez, L.; Valderrama, J. Primary Amputation for Patients P.; Lugo, L. H. With Severe Lower Limb Trauma in Colombia Chung, K. C.; Saddawi- A cost-utility analysis of 2009 Plast Reconstr Surg Cost Analysis Konefka, D.; Haase, S. C.; amputation versus salvage for Kaul, G. Gustilo type IIIB and IIIC open tibial fractures Covey, D. C. Conversion From Limb Salvage 2015 J Surg Orthop Adv Systematic Reviews References Reviewed to Late Amputation: Lessons Learned From Recent Battlefields With Application to Civilian Trauma Pinzur, M. S.; Gottschalk, Controversies in lower 2008 Instr Course Lect Systematic Reviews review F.; Pinto, M. A.; Smith, D. extremity amputation G. Fortuna, G.; DuBose, J. J.; Contemporary outcomes of 2016 J Trauma Acute Care Patient/Injury factors for LS No controlled comparison; Mendelsberg, R.; Inaba, lower extremity vascular repairs Surg or Amp No relevant RFs K.; Haider, A.; Joseph, B.; extending below the knee: A Skarupa, D.; Selleck, M. J.; multicenter retrospective study O'Callaghan, T. A.; Charlton-Ouw, K. Liang, N. L.; Alarcon, L. H.; Contemporary outcomes of 2016 J Vasc Surg Immediate amputation Mixed Etiology Jeyabalan, G.; Avgerinos, civilian lower extremity arterial factors; Patient/Injury E. D.; Makaroun, M. S.; trauma factors for LS or Amp Chaer, R. A. Ovaska, M. T.; Madanat, Contemporary demographics 2015 Injury Patient/Injury factors for LS No Controlled R.; Honkamaa, M.; and complications of patients or Amp Comparison; Mixed MÃ¤kinen, T. J. treated for open ankle fractures Etiology

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Ali, M. M.; Loretz, L.; A contemporary comparative 2013 Ann Vasc Surg Environmental factors for LS mixed etiology; unclear Shea, A.; Poorvu, E.; analysis of immediate or Amp etiology Robinson, W. P.; Schanzer, postoperative prosthesis A.; Messina, L. M.; Baril, placement following below- D. T. knee amputation de Mestral, C.; Sharma, S.; A contemporary analysis of the 2013 J Trauma Acute Care Immediate amputation amputation/salvage Haas, B.; Gomez, D.; management of the mangled Surg factors outcome; univariate data Nathens, A. B. lower extremity is retrospective Moniz, M. P.; Ombrellaro, Concomitant orthopedic and 1997 Am Surg Patient/Injury factors for LS retrospective, univariate - M. P.; Stevens, S. L.; vascular injuries as predictors or Amp very low quality Freeman, M. B.; Diamond, for limb loss in blunt lower D. L.; Goldman, M. H. extremity trauma Wening, J. V.; Skruodies, Compound fractures of the 1990 Br J Clin Pract Immediate amputation No Controlled B.; Schontag, H.; lower leg: clinical experiences factors Comparisons Jungbluth, K. H. and concept of treatment in multiple injury patients Velinovic, M. M.; Complications of operative 2000 Cardiovasc Surg Patient/Injury factors for LS No comparison group; No Davidovic, B. L.; Lotina, I. treatment of injuries of or Amp relevant RFs; mixed S.; Vranes, R. M.; Djukic, L. peripheral arteries etiology P.; Arsov, J. V.; Ristic, V. M.; Kocica, J. M.; Petrovic, L. P. Phisitkul, P.; McKinley, T. Complications of locking plate 2007 J Orthop Trauma Patient/Injury factors for LS retrospective, univariate - O.; Nepola, J. V.; Marsh, J. fixation in complex proximal or Amp very low quality L. tibia injuries Brown, K. V.; Ramasamy, Complications of extremity 2009 J Trauma Immediate amputation mixed extremity A.; Tai, N.; MacLeod, J.; vascular injuries in conflict factors Midwinter, M.; Clasper, J. C. Khatri, K.; Sharma, V.; Complications in the 2016 Chin J Traumatol Patient/Injury factors for LS very low quality Goyal, D.; Farooque, K. management of closed high- or Amp energy proximal tibial plateau fractures Harris, A. M.; Althausen, Complications following limb- 2009 J Orthop Trauma Patient/Injury factors for LS Prospective univariate; P. L.; Kellam, J.; Bosse, M. threatening lower extremity or Amp very low quality J.; Castillo, R. trauma

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Ritenour, A. E.; Dorlac, W. Complications after fasciotomy 2008 J Trauma Patient/Injury factors for LS No Controlled C.; Fang, R.; Woods, T.; revision and delayed or Amp Comparison; Mixed Jenkins, D. H.; Flaherty, S. compartment release in combat population F.; Wade, C. E.; Holcomb, patients J. B. Koval, K. J.; Zhou, W.; Complications after ankle 2007 Foot Ankle Int Immediate amputation age range doesn't fit the Sparks, M. J.; Cantu, R. V.; fracture in elderly patients factors population of interest Hecht, P.; Lurie, J. Busse, J. W.; Jacobs, C. L.; Complex limb salvage or early 2007 J Orthop Trauma Systematic Reviews References Reviewed. Swiontkowski, M. F.; amputation for severe lower- Bosse, M. J.; Bhandari, M. limb injury: a meta-analysis of observational studies Lowenberg, D. W.; Complex limb reconstruction 2015 Techniques in Patient/Injury factors for LS No Controlled Githens, M. with simultaneous muscle Orthopaedics or Amp Comparison; No transfer and circular external comparison fixation Schepers, T.; Rammelt, S. Complex Foot Injury: Early and 2017 Foot Ankle Clin Patient/Injury factors for LS Commentary; no usable Definite Management or Amp data Kragh, J. F., Jr.; San Compartment syndrome 2013 J Trauma Acute Care Environmental factors for LS No Controlled Antonio, J.; Simmons, J. performance improvement Surg or Amp Comparison; Mixed W.; Mace, J. E.; Stinner, D. project is associated with population J.; White, C. E.; Fang, R.; increased combat casualty Aden, J. K.; Hsu, J. R.; survival Eastridge, B. J.; Jenkins, D. H.; Ritchie, J. D.; Hardin, M. O.; Ritenour, A. E.; Wade, C. E.; Blackbourne, L. H. Frink, M.; Hildebrand, F.; Compartment syndrome of the 2010 Clin Orthop Relat Res Patient/Injury factors for LS Commentary; no usable Krettek, C.; Brand, J.; lower leg and foot or Amp data Hankemeier, S. Aydin, A.; Atic, R. Comparison of the demographic 2018 J Back Musculoskelet Immediate amputation No RF of interest and clinical characteristics, Rehabil factors functional status and quality of life of lower extremity amputees to identify the reason for undergoing amputation

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Berke, G. M.; Fergason, J.; Comparison of satisfaction with 2010 J Rehabil Res Dev Environmental factors for LS prospective univariate; Milani, J. R.; Hattingh, J.; current prosthetic care in or Amp very low quality McDowell, M.; Nguyen, veterans and servicemembers V.; Reiber, G. E. from Vietnam and OIF/OEF conflicts with major traumatic limb loss Wei, S. J.; Cai, X. H.; Wang, A comparison of primary and 2014 Int J Surg Patient/Injury factors for LS *wound management* H. S.; Qi, B. W.; Yu, A. X. delayed wound closure in or Amp severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage: a case- controlled study Keeling, J. J.; Shawen, S. Comparison of functional 2013 J Bone Joint Surg Am Environmental factors for LS No relevant RFs B.; Forsberg, J. A.; Kirk, K. outcomes following bridge or Amp L.; Hsu, J. R.; Gwinn, D. E.; synostosis with non-bone- Potter, B. K. bridging transtibial combat- related amputations Linberg, A. A.; Roach, K. Comparison of 6-minute walk 2013 J Rehabil Res Dev Environmental factors for LS No comparison group; No E.; Campbell, S. M.; test performance between male or Amp relevant RFs Stoneman, P. D.; Active Duty soldiers and Gaunaurd, I. A.; Raya, M. servicemembers with and A.; Gomez-Orozco, C.; without traumatic lower-limb Gailey, R. S. loss Staruch, R. M.; Jackson, P. Comparing the surgical 2016 Ann Med Surg (Lond) Patient/Injury factors for LS No Controlled Comparison C.; Hodson, J.; Yim, G.; timelines of military and or Amp Foster, M. A.; Cubison, T.; civilians traumatic lower limb Jeffery, S. L. amputations Patzkowski, J. C.; Blanck, Comparative effect of orthosis 2012 J Bone Joint Surg Am Environmental factors for LS Mixed Etiology R. V.; Owens, J. G.; design on functional or Amp Wilken, J. M.; Kirk, K. L.; performance Wenke, J. C.; Hsu, J. R. Ohmine, S.; Kimura, Y.; Community-based survey of 2012 Prosthet Orthot Int Patient/Injury factors for LS Mixed Etiology Saeki, S.; Hachisuka, K. amputation derived from the or Amp physically disabled person's certification in Kitakyushu City, Japan

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Seitz, I. A.; Lee, J. C.; Sulo, Common characteristics of 2017 European Journal of Patient/Injury factors for LS Retrospective Univariate; S.; Shah, V.; Shah, M.; functional and adverse Plastic Surgery or Amp very low quality Jimenez, M. L.; Schechter, outcomes in acute lower- L. S. extremity trauma reconstruction Hollenbeck, S. T.; Woo, S.; The combined use of the Ilizarov 2009 Ann Plast Surg Patient/Injury factors for LS Amputation/Salvage as Ong, S.; Fitch, R. D.; method and microsurgical or Amp Outcome Erdmann, D.; Levin, L. S. techniques for limb salvage McKee, M. D.; Yoo, D. J.; Combined single-stage osseous 2008 J Orthop Trauma Immediate amputation No comparison of interest Zdero, R.; Dupere, M.; and soft tissue reconstruction of factors Wild, L.; Schemitsch, E. H.; the tibia with the Ilizarov Mahoney, J. method and tissue transfer Desai, P.; Audige, L.; Suk, Combined orthopedic and 2012 Am J Orthop (Belle Immediate amputation No controlled comparison M. vascular lower extremity Mead NJ) factors injuries: sequence of care and outcomes Odland, M. D.; Gisbert, V. Combined orthopedic and 1990 Surgery Immediate amputation Amp/Sal as outcome; L.; Gustilo, R. B.; Ney, A. vascular injury in the lower factors retrospective univariate L.; Blake, D. P.; Bubrick, extremities: indications for M. P. amputation Purcell, R. L.; Donohue, M. Combat-related acetabular 2018 Injury Patient/Injury factors for LS No Controlled Comparison A.; Saxena, S. K.; Gordon, fractures: Outcomes of open or Amp W. T.; Lewandowski, L. L. versus closed injuries Jones, P. E.; Meyer, R. M.; Combat Injury of the Sciatic 2018 Mil Med Patient/Injury factors for LS No Controlled Comparison Faillace, W. J.; Landau, M. Nerve - An Institutional or Amp E.; Smith, J. K.; McKay, P. Experience L.; Nest, L. J. Ortiz, D., 3rd; Blair, J. A.; Collaborative Establishment of 2015 J Surg Orthop Adv Environmental factors for LS No Controlled Comparison Dromsky, D. M.; Pyo, J.; an Integrated Orthotic and or Amp Owens, J. G.; Hsu, J. R. Rehabilitation Pathway Van Eck, C. F.; McGough, Clinical outcome of 2015 Current Orthopaedic Systematic Reviews References Reviewed R. L. osseointegrated prostheses for Practice lower extremity amputations: A systematic review of the literature

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Ballas, R.; Saetta, G.; Clinical features of 27 shark 2017 Journal of Trauma Immediate amputation mixed extremity Peuchot, C.; Elkienbaum, attack cases on La RÃ©union and Acute Care factors P.; Poinsot, E. Island Surgery Zhang, X.; Liu, Y.; Peng, A.; Clinical efficacy and prognosis 2015 International Journal Patient/Injury factors for LS No Controlled Comparison Wang, H.; Zhang, Y. factors of open calcaneal of Clinical and or Amp fracture: A retrospective study Experimental Medicine Zhang, Z. Y.; Feng, S. M.; Clinical application of 2015 Eur Rev Med Patient/Injury factors for LS No Controlled Zhou, M. M.; Tao, Y. L.; anterolateral thigh perforator Pharmacol Sci or Amp Comparison; Mixed Wang, A. G. flap for the reconstruction of Etiology severe tibia exposure Sproule, J. A.; Chin, T.; Clinical and radiographic 2013 Foot and Ankle Patient/Injury factors for LS Doesn't address question Amin, A.; Daniels, T.; outcomes of the Mobility Total International or Amp of interest; Younger, A. S.; Boyd, G.; Ankle arthroplasty system: Early Glazebrook, M. A. results from a prospective multicenter study Banderker, M. A.; Civilian popliteal artery injuries 2012 S Afr J Surg Immediate amputation No Controlled Navsaria, P. H.; Edu, S.; factors Comparisons Bekker, W.; Nicol, A. J.; Naidoo, N. Kusljugic, A.; Kapidzic- Chronic low back pain in 2006 Bosn J Basic Med Sci Patient/Injury factors for LS No comparison group; No Durakovic, S.; Kudumovic, individuals with lower-limb or Amp relevant RFs Z.; Cickusic, A. amputation Klaue, K. Chopart fractures 2004 Injury Systematic Reviews review Chiu, Y. C.; Chung, T. C.; Chopart amputation with 2018 Bone Joint J Patient/Injury factors for LS No relevant RFs Wu, C. H.; Tsai, K. L.; Jou, tibiotalocalcaneal arthrodesis or Amp I. M.; Tu, Y. K.; Ma, C. H. and free flap reconstruction for severe foot crush injury MacKenzie, E. J.; Bosse, Characterization of patients 2000 J Orthop Trauma Immediate amputation Amputation/Salvage as M. J.; Kellam, J. F.; with high-energy lower factors Outcome Burgess, A. R.; Webb, L. extremity trauma X.; Swiontkowski, M. F.; Sanders, R. W.; Jones, A. L.; McAndrew, M. P.; Patterson, T. M.; McCarthy, M. L.

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Tennent, D. J.; Polfer, E. Characterization of disability 2018 Injury Patient/Injury factors for LS Retrospective Univariate; M.; Sgromolo, N. M.; following traumatic through or Amp very low quality Krueger, C. A.; Potter, B. knee and transfemoral K. amputations Li, Z.; Zhao, L.; Wang, K.; Characteristics and treatment of 2014 Int J Clin Exp Med Immediate amputation mixed etiology Cheng, J.; Zhao, Y.; Ren, vascular injuries: a review of factors W. 387 cases at a Chinese center Dou, C.; Liu, Y.; Wang, Q.; Characteristics and outcomes of 2016 International Journal Immediate amputation mixed extremity Zhang, Y. traumatic major extremity of Clinical and factors amputations in Chinese Experimental population Medicine Connolly, M.; Ibrahim, Z. Changing paradigms in lower 2016 Mil Med Res Systematic Reviews Systematic review; R.; Johnson, O. N., 3rd extremity reconstruction in war- related injuries Jacobs, N.; Taylor, D. M.; Changes in surgical workload at 2012 Injury Environmental factors for LS No controlled comparison; Parker, P. J. the JF Med Gp Role 3 Hospital, or Amp No relevant RFs Camp Bastion, Afghanistan, November 2008-November 2010 Taddeo, J.; Devine, M.; Cervical spine injury in 2015 Can J Surg Patient/Injury factors for LS Upper limb injury; No McAlister, V. C. dismounted improvised or Amp Controlled Comparison explosive device trauma Pala, E.; Mavrogenis, A. F.; Cemented versus cementless 2013 Journal of B.U.ON. Immediate amputation Cancer pts Angelini, A.; Henderson, E. endoprostheses for lower limb factors R.; Letson, G. D.; Ruggieri, salvage surgery P. Singleton, J. A.; Walker, N. Case suitability for definitive 2014 J R Army Med Corps Immediate amputation mixed extremity; no M.; Gibb, I. E.; Bull, A. M.; through knee amputation factors stratified data of interest Clasper, J. C. following lower extremity blast trauma: analysis of 146 combat casualties, 2008-2010 Lantry, J. M.; Perumal, V.; Can patterns of segmental 2009 J Surg Orthop Adv Immediate amputation No controlled comparison Roberts, C. S. injuries of the foot and ankle factors predict amputation and disability?

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Wardak, M.; Wardak, E.; Calcanisation of tibia using 2008 Int Orthop Patient/Injury factors for LS No Controlled Goel, A. Ilizarov fixator in crush injuries or Amp Comparison; No relevant of hindfoot: a new method RFs Gitajn, I. L.; Abousayed, Calcaneal avulsion fractures: a 2015 Foot Ankle Spec Patient/Injury factors for LS Unclear trauma; mixed M.; Toussaint, R. J.; case series of 33 patients or Amp etiology Vrahas, M.; Kwon, J. Y. describing prognostic factors and outcomes Kennedy, P. J.; Young, W. Burns and amputations: a 24- 2006 J Burn Care Res Immediate amputation Mixed etiology; mixed M.; Deva, A. K.; Haertsch, year experience factors population P. A. Kim, P. S.; Malin, E.; The Boston marathon 2013 Plast Reconstr Surg Patient/Injury factors for LS Case series; mixed Kirkham, J. C.; Helliwell, L. bombings: the early plastic or Amp population A.; Ibrahim, A. M.; Tobias, surgery experience of one A. M.; Upton, J.; Lee, B. T.; Boston hospital Lin, S. J. Pelissier, P.; Boireau, P.; Bone reconstruction of the 2003 Plast Reconstr Surg Patient/Injury factors for LS No controlled comparison; Martin, D.; Baudet, J. lower extremity: complications or Amp No relevant RFs and outcomes Flint, J. H.; Wade, A. M.; Bone mineral density loss after 2014 J Orthop Trauma Environmental factors for LS No Controlled Comparison Stocker, D. J.; Pasquina, P. combat-related lower extremity or Amp F.; Howard, R. S.; Potter, amputation B. K. Harrell, D. J.; Spain, D. A.; Blunt popliteal artery trauma: a 1997 Am Surg Patient/Injury factors for LS Amputation/Salvage as Bergamini, T. M.; Miller, F. challenging injury or Amp Outcome B.; Richardson, J. D. Hossny, A. Blunt popliteal artery injury with 2004 J Vasc Surg Immediate amputation No Controlled complete lower limb ischemia: factors Comparisons is routine use of temporary intraluminal arterial shunt justified? Abou-Sayed, H.; Berger, D. Blunt lower-extremity trauma 2002 Arch Surg Immediate amputation Mixed population L. and popliteal artery injuries: factors revisiting the case for selective arteriography Singleton, J. A.; Gibb, I. E.; Blast-mediated traumatic 2014 J R Army Med Corps Patient/Injury factors for LS No Controlled Bull, A. M.; Clasper, J. C. amputation: evidence for a or Amp Comparison; Mixed population

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Gwinn, D. E.; Tintle, S. M.; Blast-induced lower extremity 2011 J Orthop Trauma Patient/Injury factors for LS No controlled comparisons Kumar, A. R.; Andersen, R. fractures with arterial injury: or Amp; Environmental ; very low quality C.; Keeling, J. J. prevalence and risk factors for factors for LS or Amp amputation after initial limb- preserving treatment Watson, J. D.; Gifford, S. Biochemical markers of acute 2014 Semin Vasc Surg review M.; Clouse, W. D. limb ischemia, rhabdomyolysis, and impact on limb salvage Dougherty, P. J.; Bilateral 2014 Clin Orthop Relat Res Environmental factors for LS Mixed population McFarland, L. V.; Smith, D. transfemoral/transtibial or Amp G.; Reiber, G. E. amputations due to battle injuries: a comparison of Vietnam veterans with Iraq and Afghanistan servicemembers Cui, S.; Bauer, J. M.; Mir, Bilateral tibial shaft fractures: A 2017 Current Orthopaedic Patient/Injury factors for LS No comparison group; No H.; Cannada, L. K. multicenter analysis Practice or Amp relevant RFs Lisboa, F. A.; Forsberg, J. Bilateral lower-extremity 2013 Surgery Patient/Injury factors for LS mixed extremity; No A.; Brown, T. S.; Gage, F. amputation wounds are or Amp usable data A.; Potter, B. K.; Elster, E. associated with distinct local A. and systemic cytokine response Atesalp, A. S.; Erler, K.; Bilateral lower limb 1999 Prosthet Orthot Int Environmental factors for LS No Controlled Comparison Gur, E.; Koseglu, E.; amputations as a result of or Amp Kirdemir, V.; Demiralp, B. landmine injuries Schmidhammer, R.; Bilateral lower leg replantation 2004 J Trauma Patient/Injury factors for LS 3 patients Nimmervoll, R.; Pelinka, L. versus prosthetic replacement: or Amp E.; Huber, W.; Schrei, K.; long-term outcome of Kroepfl, A.; Redl, H. amputation after an occupational railroad accident Scalea, J. R.; Crawford, R.; Below-the-knee arterial injury: 2014 J Trauma Acute Care Immediate amputation Amp/Sal as outcome Scurci, S.; Danquah, J.; the type of vessel may be more Surg factors Sarkar, R.; Kufera, J.; important than the number of O'Connor, J.; Scalea, T. M. vessels injured

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Simper, L. B. Below knee amputation in war 1993 J Trauma Immediate amputation No usable data surgery: a review of 111 factors amputations with delayed primary closure Barros D'Sa, A. A.; Harkin, The Belfast approach to 2006 Eur J Vasc Endovasc Environmental factors for LS no controlled comparison D. W.; Blair, P. H.; Hood, J. managing complex lower limb Surg or Amp M.; McIlrath, E. vascular injuries Hinsley, D. E.; Phillips, S. Ballistic fractures during the 2006 J R Army Med Corps Patient/Injury factors for LS Mixed extremity; no L.; Clasper, J. S. 2003 Gulf conflict--early or Amp relevant RFs; prognosis and high complication rate Degiannis, E.; Bowley, D. Ballistic arterial trauma to the 2007 Am Surg Immediate amputation No comparison of interest M.; Bode, F.; Lynn, W. R.; lower extremity: recent South factors Glapa, M.; Baxter, S.; African experience Shapey, J.; Smith, M. D.; Doll, D. Horst, F.; Gilbert, B. J.; Avascular necrosis of the talus: 2004 Foot and Ankle Patient/Injury factors for LS Commentary; no usable Nunley, J. A. Current treatment options Clinics or Amp data Adelaar, R. S.; Madrian, J. Avascular necrosis of the talus 2004 Orthopedic Clinics of Patient/Injury factors for LS Review/Commentary; no R. North America or Amp usable data Myeroff, C.; Archdeacon, Autogenous bone graft: Donor 2011 Journal of Bone and Systematic Reviews review M. sites and techniques Joint Surgery - Series A Shackelford, S. A.; Del Association of Prehospital Blood 2017 Jama Environmental factors for LS Mixed Extremity Junco, D. J.; Powell- Product Transfusion During or Amp Dunford, N.; Medical Evacuation of Combat Mazuchowski, E. L.; Casualties in Afghanistan With Howard, J. T.; Kotwal, R. Acute and 30-Day Survival S.; Gurney, J.; Butler, F. K., Jr.; Gross, K.; Stockinger, Z. T. Kulkarni, J.; Adams, J.; Association between 1998 Clin Rehabil Patient/Injury factors for LS No relevant RFs Thomas, E.; Silman, A. amputation, arthritis and or Amp osteopenia in British male war veterans with major lower limb amputations

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Morrison, J. J.; Hunt, N.; Associated injuries in casualties 2012 Br J Surg Immediate amputation No Controlled Comparison Midwinter, M.; Jansen, J. with traumatic lower extremity factors amputations caused by improvised explosive devices Bosse, M. J.; Murray, C. K.; Assessment of Severe Extremity 2017 J Orthop Trauma Patient/Injury factors for LS No relevant RFs Carlini, A. R.; Firoozabadi, Wound Bioburden at the Time or Amp R.; Manson, T.; of Definitive Wound Closure or Scharfstein, D. O.; Wenke, Coverage: Correlation With J. C.; Zadnik, M.; Castillo, Subsequent Postclosure Deep R. C. Wound Infection (Bioburden Study) Kwasnicki, R. M.; Assessing functional mobility 2015 Ann Surg Immediate amputation No Risk Factor of Interest Hettiaratchy, S.; Jarchi, D.; after lower limb reconstruction: factors Nightingale, C.; a psychometric evaluation of a Wordsworth, M.; sensor-based mobility score Simmons, J.; Yang, G. Z.; Darzi, A. Faris, I. B.; Raptis, S.; Arterial injury in the lower limb 1997 Aust N Z J Surg Immediate amputation No Controlled Comparison Fitridge, R. from blunt trauma factors; Patient/Injury factors for LS or Amp Sriussadaporn, S. Arterial injuries of the lower 1997 J Med Assoc Thai Immediate amputation No controlled comparisons extremity from blunt trauma factors Andrikopoulos, V.; Arterial injuries associated with 1995 Cardiovasc Surg Patient/Injury factors for LS Mixed Etiology Antoniou, I.; Panoussis, P. lower-extremity fractures or Amp Quirke, T. E.; Sharma, P. Are type IIIC lower extremity 1996 J Trauma Immediate amputation no controlled comparison K.; Boss, W. K., Jr.; injuries an indication for factors Oppenheim, W. C.; primary amputation Rauscher, G. E. Papadakis, S. A.; Anti-personnel landmine 2006 Prehosp Disaster Immediate amputation Case Series Babourda, E. C.; injuries during peace: Med factors Mitsitskas, T. C.; experience in a European Markakidis, S.; Bachtis, C.; country Koukouvis, D.; Tentes, A. A. Helgeson, M. D.; Potter, B. Antibiotic-impregnated calcium 2009 Orthopedics Environmental factors for LS Mixed extremity; no K.; Tucker, C. J.; Frisch, H. sulfate use in combat-related or Amp relevant RF M.; Shawen, S. B. open fractures 180

Park, J. E.; Rodriguez, E. The anterolateral thigh flap is 2007 J Trauma Immediate amputation No usable data D.; Bluebond-Langer, R.; highly effective for factors; Patient/Injury Bochicchio, G.; Christy, M. reconstruction of complex lower factors for LS or Amp R.; Bochicchio, K.; Scalea, extremity trauma T. M. Bal, G. K.; Kuo, R. S.; The anterior T-frame external 2000 Clin Orthop Relat Res Patient/Injury factors for LS No comparison group Chapman, J. R.; Henley, fixator for high-energy proximal or Amp M. B.; Benirschke, S. K.; tibial fractures Claudi, B. F. Moehring, H. D.; Tan, R. Ankle dislocation 1994 J Orthop Trauma Immediate amputation No Controlled Comparison T.; Marder, R. A.; Lian, G. factors Jana Neto, F. C.; de Paula Analysis of the characteristics of 2016 Rev Bras Ortop Immediate amputation No Controlled Comparison Canal, M.; Alves, B. A.; patients with open tibial factors Ferreira, P. M.; Ayres, J. fractures of Gustilo and C.; Alves, R. Anderson type III Webb, L. X.; Bosse, M. J.; Analysis of surgeon-controlled 2007 J Bone Joint Surg Am Environmental factors for LS Prospective univariate; Castillo, R. C.; MacKenzie, variables in the treatment of or Amp very low quality E. J. limb-threatening type-III open tibial diaphyseal fractures Hu, R.; Ren, Y. J.; Yan, L.; Analysis of Staged Treatment 2018 Indian J Orthop Patient/Injury factors for LS No relevant RFs Yi, X. C.; Ding, F.; Han, Q.; for Gustilo Anderson IIIB/C or Amp Cheng, W. J. Open Tibial Fractures Yip, V. S.; Teo, N. B.; An analysis of risk factors 2006 World J Surg Patient/Injury factors for LS Wrong population; non- Johnstone, R.; Robertson, associated with failure of below or Amp trauma; A. G.; Robertson, J. H.; knee amputations Welch, G. H.; Kettlewell, S. Dillingham, T. R.; Analysis of casualties referred to 1993 Am J Phys Med Patient/Injury factors for LS No Controlled Spellman, N. T.; Army physical medicine services Rehabil or Amp Comparison; Mixed Braverman, S. E.; Zeigler, during the Persian Gulf conflict extremity D. N.; Belandres, P. V.; Bryant, P. R.; Salcedo, V. L.; Schneider, R. L. Salimi, J.; Abbasi, M.; Analysis of 274 patients with 2009 Chin J Traumatol Immediate amputation No Controlled Comparison Khaji, A.; Zargar, M. extremity injuries caused by the factors Bam earthquake

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Moore, J.; Berberian, W. An analysis of 2 fusion methods 2015 Foot Ankle Int Patient/Injury factors for LS No Controlled Comparison S.; Lee, M. for the treatment of or Amp osteomyelitis following fractures about the ankle Korver, A. J. Amputees in a hospital of the 1993 Injury Patient/Injury factors for LS *mixed-upper & lower International Committee of the or Amp extremity* Red Cross Raya, M. A.; Gailey, R. S.; Amputee mobility predictor- 2013 J Rehabil Res Dev Environmental factors for LS No usable data Gaunaurd, I. A.; Ganyard, bilateral: a performance-based or Amp H.; Knapp-Wood, J.; measure of mobility for people McDonough, K.; with bilateral lower-limb loss Palmisano, T. Baum, B. S.; Hobara, H.; Amputee Locomotion: Ground 2016 J Appl Biomech Environmental factors for LS Mixed etiology; no Kim, Y. H.; Shim, J. K. Reaction Forces During or Amp comparison group Submaximal Running With Running-Specific Prostheses Amputations of upper and lower 2012 Msmr Patient/Injury factors for LS No Controlled extremities, active and reserve or Amp Comparison; No usable components, U.S. Armed Forces, data 2000-2011 Stansbury, L. G.; Lalliss, S. Amputations in U.S. military 2008 J Orthop Trauma Patient/Injury factors for LS No Controlled Comparison J.; Branstetter, J. G.; Bagg, personnel in the current or Amp M. R.; Holcomb, J. B. conflicts in Afghanistan and Iraq Soroush, A.; Falahati, F.; Amputations due to landmine 2008 Arch Iran Med Immediate amputation No usable data; does not Zargar, M.; Soroush, M.; and unexploded ordinances in factors address question of Khateri, S.; Khaji, A. post-war Iran interest; Chaloner, E. J.; Flora, H. S.; Amputations at the London 2001 Journal of the Royal Immediate amputation Mixed population; unclear Ham, R. J. hospital 1852-1857 Society of Medicine factors trauma van Dongen, T. T.; Amputation: Not a failure for 2017 Injury Patient/Injury factors for LS No relevant RFs Huizinga, E. P.; de Kruijff, severe lower extremity combat or Amp L. G.; van der Krans, A. C.; injury Hoogendoorn, J. M.; Leenen, L. P.; Hoencamp, R.

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Hertel, R.; Strebel, N.; Amputation versus 1996 J Orthop Trauma Patient/Injury factors for LS prospective univariate; Ganz, R. reconstruction in traumatic or Amp very low quality defects of the leg: outcome and costs Demiralp, B.; Ege, T.; Amputation versus functional 2014 Eur J Orthop Surg Immediate amputation No Controlled Comparison Kose, O.; Yurttas, Y.; reconstruction in the Traumatol factors Basbozkurt, M. management of complex hind foot injuries caused by landmine explosions: a long-term retrospective comparison Fioravanti, M.; Maman, Amputation versus conservative 2018 Orthop Traumatol Patient/Injury factors for LS No relevant RFs P.; Curvale, G.; treatment in severe open lower- Surg Res or Amp Rochwerger, A.; Mattei, J. limb fracture: A functional and C. quality-of-life study Tomaino, M. M. Amputation or salvage of type 2001 Am J Orthop (Belle review 3B/3C tibial fractures: what the Mead NJ) literature says about outcomes Jacobs, C.; Siozos, P.; Amputation of a lower 2011 Oper Orthop Immediate amputation Commentary; no usable Raible, C.; Wendl, K.; extremity after severe trauma Traumatol factors data Frank, C.; Grutzner, P. A.; Wolfl, C. Mohamed, I. A.; Ahmed, Amputation and prostheses in 1997 J R Coll Surg Edinb Patient/Injury factors for LS mixed etiology A. R.; Ahmed, M. E. Khartoum or Amp Hill, S. W.; Patla, A. E.; Altered kinetic strategy for the 1999 Journal of Environmental factors for LS Population n<10 Ishac, M. G.; Adkin, A. L.; control of swing limb elevation Biomechanics or Amp Supan, T. J.; Barth, D. G. over obstacles in unilateral below-knee amputee gait Penn-Barwell, J. G.; Fries, Aggressive soft tissue infections 2012 J R Nav Med Serv Immediate amputation prospective univariate; C. A.; Sargeant, I. D.; and amputation in military factors very low quality Bennett, P. M.; Porter, K. trauma patients Mundy, L. R.; Truong, T.; Acute Treatment Patterns for 2017 J Reconstr Microsurg Patient/Injury factors for LS Amputation/Salvage as Shammas, R. L.; Gage, M. Lower Extremity Trauma in the or Amp; Environmental Outcome J.; Pomann, G. M.; United States: Flaps versus factors for LS or Amp Hollenbeck, S. T. Amputation

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Hayakawa, H.; Aldington, Acute traumatic compartment 2009 Trauma Patient/Injury factors for LS Mixed population D. J.; Moore, R. A. syndrome: A systematic review or Amp of results of fasciotomy Penn-Barwell, J. G.; Acute bilateral leg amputation 2014 Injury Immediate amputation No usable data Bennett, P. M.; Kay, A.; following combat injury in UK factors Sargeant, I. D. servicemen Asfar, S.; Al-Ali, J.; Safar, 155 vascular injuries: a 2002 Eur J Surg Immediate amputation No Controlled H.; Al-Bader, M.; Farid, E.; retrospective study in Kuwait, factors Comparison; Mixed Ali, A.; Kansou, J. 1992-2000 population; Mixed etiology Akkas, M.; Ay, D.; Metin 10-year evaluation of train 2011 Ulus Travma Acil Immediate amputation Mixed population Aksu, N.; Gunalp, M. accidents Cerrahi Derg factors Franz, R. W.; Shah, K. J.; A 5-year review of management 2011 J Vasc Surg Patient/Injury factors for LS No comparison group Halaharvi, D.; Franz, E. T.; of lower extremity arterial or Amp Hartman, J. F.; Wright, M. injuries at an urban level I L. trauma center Bibbo, C.; Siddiqui, N.; Wound Coverage Options for 2018 Clinics in Podiatric review Fink, J.; Powers, J.; Ehrlich, Soft Tissue Defects Following Medicine and D. A.; Kovach, S. J. Calcaneal Fracture Management Surgery (Operative/Surgical) Lee, M.; Choi, W. J.; Han, Uncontrolled diabetes as a 2018 Foot and Ankle Patient/Injury factors for LS not high-energy; S. H.; Jang, J.; Lee, J. W. potential risk factor in Surgery or Amp tibiotalocalcaneal fusion using a retrograde intramedullary nail Reiber, G. E.; McFarland, Servicemembers and veterans 2010 J Rehabil Res Dev Environmental factors for LS Retrospective Univariate; L. V.; Hubbard, S.; with major traumatic limb loss or Amp very low quality Maynard, C.; Blough, D. from Vietnam war and OIF/OEF K.; Gambel, J. M.; Smith, conflicts: survey methods, D. G. participants, and summary findings Eskridge, S. L.; Clouser, M. Self-Reported Functional Status 2019 Am J Phys Med Patient/Injury factors for LS prospective univariate; C.; McCabe, C. T.; in US Service Members After Rehabil or Amp very low quality Watrous, J. R.; Galarneau, Combat-Related Amputation M. R. Yang, X.; Yan, H.; Fan, Y.; Risk factors of free anterolateral 2018 International Journal Patient/Injury factors for LS Mixed trauma Dong, J.; Cai, Y.; Li, Z. thigh flap failure for of Clinical and or Amp reconstruction of lower-limb Experimental defects: A 10-year experience Medicine 184

Roepke, A. M.; Turner, A. A Prospective Longitudinal 2018 Arch Phys Med Patient/Injury factors for LS no high-energy P.; Henderson, A. W.; Study of Trajectories of Rehabil or Amp Goldberg, S. B.; Norvell, D. Depressive Symptoms after C.; Czerniecki, J. M.; Dysvascular Amputation Williams, R. M. Ladlow, P.; Bennett, N.; Passive-dynamic ankle-foot 2018 J R Army Med Corps Environmental factors for LS Retrospective Univariate; Phillip, R.; Dharm-Datta, orthosis improves medium-term or Amp very low quality S.; McMenemy, L.; clinical outcomes after severe Bennett, A. N. lower extremity trauma Butler, W. J.; Calvo, R. Y.; Outcomes for popliteal artery 2019 J Trauma Acute Care Immediate amputation Unclear trauma Sise, M. J.; Bowie, J. M.; injury repair after discharge: A Surg factors Wessels, L. E.; Bansal, V.; large-scale population-based Beth Sise, C. analysis Polfer, E. M.; Hoyt, B. W.; Knee Disarticulation versus 2019 J Orthop Trauma Patient/Injury factors for LS No RF of interest Bevevino, A. J.; Forsberg, Transfemoral Amputations: or Amp J. A.; Potter, B. K. Functional Outcomes Russell Esposito, E.; Experimental comparisons of 2018 J Neuroeng Rehabil Environmental factors for LS Schmidtbauer, K. A.; passive and powered ankle-foot or Amp Wilken, J. M. orthoses in individuals with limb reconstruction Wareham, A. P.; Sparkes, Effect of one session of mirror 2018 J R Army Med Corps Patient/Injury factors for LS does not address question V. therapy on phantom limb pain or Amp of interest and recognition of limb laterality in military traumatic lower limb amputees: a pilot study Haddix, K. P.; Clement, R. Complications Following 2018 Foot & ankle Patient/Injury factors for LS Incorrect pts population C.; Tennant, J. N.; Ostrum, Operatively Treated Ankle specialist or Amp R. F. Fractures in Insulin- and Non- Insulin-Dependent Diabetic Patients Van Niekerk, A. H.; Circular external fixation and 2017 Journal of Patient/Injury factors for LS doesn't address question Birkholtz, F. F.; De Lange, cemented PMMA spacers for Orthopaedic Surgery or Amp of interest P.; Tetsworth, K.; the treatment of complex tibial Hohmann, E. fractures and infected nonunions with segmental bone loss

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Rollo, G.; Falzarano, G.; Challenges in the management 2018 Injury Patient/Injury factors for LS No rf of interest Ronga, M.; Bisaccia, M.; of floating knee injuries: Results or Amp Grubor, P.; Erasmo, R.; of treatment and outcomes of Rocca, G.; Tome-Bermejo, 224 consecutive cases in 10 F.; Gomez-Garrido, D.; years Pichierri, P.; Rinonapoli, G.; Meccariello, L. Eskridge, S. L.; Hill, O. T.; Association of Specific Lower 2018 Mil Med Patient/Injury factors for LS not best available; very Clouser, M. C.; Galarneau, Extremity Injuries With Delayed or Amp low quality (exploratory, M. R. Amputation retrospective) Em, S.; Karakoc, M.; Assessment of sexual function 2018 J Back Musculoskelet Patient/Injury factors for LS no comparison group Sariyildiz, M. A.; Bozkurt, and quality of life in patients Rehabil or Amp M.; Aydin, A.; Cevik, R.; with lower limb amputations Nas, K. Casey, K.; Demers, P.; Outcomes after long-term 2015 Ann Vasc Surg Patient/Injury factors for LS No controlled Deben, S.; Nelles, M. E.; follow-up of combat-related or Amp comparisons; Weiss, J. S. extremity injuries in a retrospective; very low multidisciplinary limb salvage quality clinic Sharrock, A. E.; Tai, N.; Management and outcome of 2019 J Vasc Surg very low quality Perkins, Z.; White, J. M.; 597 wartime penetrating lower Remick, K. N.; Rickard, R. extremity arterial injuries from F.; Rasmussen, T. E. an international military cohort

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AAOS CPG Approval Bodies

Committee on Evidence Based Quality and Value The committee on Evidence Based Quality and Value (EBQV) consists of twenty-three AAOS members who implement evidence-based quality initiatives such as clinical practice guidelines (CPGs), systematic literature reviews (SRs) and appropriate use criteria (AUCs). They also oversee the dissemination of related educational materials and promote the utilization of orthopaedic value products by the Academy’s leadership and its members.

Council on Research and Quality The Council on Research and Quality promotes ethically and scientifically sound clinical and translational research to sustain patient care in musculoskeletal disorders. The Council also serves as the primary resource for educating its members, the public, and public policy makers regarding evidenced-based medical practice, orthopaedic devices and biologics, regulatory pathways and standards development, patient safety, and other related important research and quality areas. The Council is comprised of the chairs of the committees on Devices, Biologics, and Technology, Patient Safety, Research Development, U.S. and chair and section leaders of the Evidence Based Quality and Value committee. Also on the Council are the second vice-president, three members at large, and representatives of the Diversity Advisory Board, Women's Health Issues Advisory Board, Board of Specialty Societies (BOS), Board of Councilors (BOC), Communications Cabinet, Orthopaedic Research Society (ORS), Orthopedic Research and Education Foundation (OREF).

Board of Directors The 17-member Board of Directors manage the affairs of the AAOS, set policy, and oversee the Strategic Plan.

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