Purpose: To systematically review reported rates of lower-limb amputation following trauma in low- and middle-income countries (LMICs) and examine disparities in outcomes across socioeconomic settings. Methodology: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE and Embase were searched using Ovid for studies reporting lower-limb amputation following traumatic injury. Eligible studies included observational cohorts, registries, and case series reporting major lower-limb amputation outcomes. Countries were classified according to World Bank income groups. The primary outcome was major lower-limb amputation, with secondary outcomes including mortality, presence of vascular injury where reported, and factors associated with limb loss. Due to heterogeneity, a narrative synthesis was performed. Results: Included studies demonstrated substantial variation in reported amputation rates following lower-limb trauma. Across LMIC settings, amputation rates were consistently higher than those reported in high-income countries when comparative data were available. Contributing factors included delayed presentation, limited access to specialist trauma and vascular services, restricted availability of imaging and revascularisation, and broader resource constraints. Studies reporting vascular injury demonstrated particularly high rates of limb loss when timely limb salvage interventions were unavailable. Conclusion: Lower-limb amputation following trauma remains disproportionately common in LMICs, reflecting persistent global inequities in trauma care and surgical capacity. These findings highlight the need for targeted trauma system strengthening, improved access to limb salvage expertise, and global health initiatives aimed at reducing preventable traumatic limb loss.