Using linked motor vehicle crash and hospital discharge records from Wisconsin under the auspices of NHTSA’ s CODES project (Crash Outcome Data Evaluation Systems), the incidence and risk factors for serious lower extremity injuries include fractures, dislocations and crushing injuries of the bones and joints of the lower extremity. Incidence rates of these injuries were 2001 100,000 crash occupants. Of those who were hospitalized following motor vehicle crash injuries, 16% were diagnosed with a serious lower extremity injury. Using logistic regression models, risk factors for both front seat passengers and drivers include crashes with frontal components, higher posted speed limits, smaller cars and vans. Age, gender and belt-use could only be included in model for drivers, showing increased risk to female drivers, especially those over 60, and a small protective effect from seatbelts. Estimates of risks for specific injuries-including foot and ankle fractures are also included.