Randomised controlled trials (RCTs), case series and retrospective case reviews were eligible for inclusion provided that participants were adults with lower extremity injury (femoral or tibial fracture and/or knee dislocation) with associated vascular injury who underwent either lower extremity fixation followed by vascular repair or vascular repair followed by fracture fixation. Fixation could include external fixation, open reduction internal fixation or intramedullary rodding. Studies were required to report amputation as an outcome. Data on injuries treated with ligation were excluded from analysis.
The included studies addressed different types of injuries: in some studies most participants had closed blunt trauma and in others most had grade III open fractures; participants in some studies had multiple injuries. The most common injury sites were the femur and femoral blood vessels (where stated). The types of amputation varied (above knee and below knee). In several studies the included participants were selected from larger case reviews (for example, of trauma admissions).
Two reviewers independently selected studies for inclusion.