1629 patients with complex lower limb fractures were randomized to receive negative pressure wound therapy (NPWT, n=813) or standard wound dressings (n=816) after surgical fixation. The primary outcome was the Disability Rating Index (DRI). Secondary outcomes included health-related quality of life (EQ-5D), pain (VAS), neuropathic pain (DN4), and complications. Outcomes were assessed annually for up to five years. Overall, the study revealed no significant differences between the groups in DRI scores, quality of life, pain levels, or complications over five years. Both groups reported persistent high disability and reduced quality of life. The findings suggest that NPWT does not provide superior long-term benefits over standard wound dressings in managing complex lower limb fractures.