BOSTON — So many patients arrived at once, with variations of the same gruesome leg injuries. Shattered bones, shredded tissue, nails burrowed deep beneath the flesh. The decision had to be made, over and over, with little time to deliberate. Should this leg be amputated? What about this one?

“As an orthopedic surgeon, we see patients like this, with mangled extremities, but we don’t see 16 of them at the same time, and we don’t see patients from blast injuries,” Dr. Peter Burke, the trauma surgery chief at Boston Medical Center, said.

The toll from the bombs Monday at the Boston Marathon, which killed at least three and injured more than 170, will long be felt by anyone involved with the city’s iconic sporting event. For the victims, the physical legacy could be an especially cruel one for a group that was involved in the marathon: severe leg trauma and amputations.

“What we like to do is before we take off someone’s leg — it’s extremely hard to make that decision — is we often get two surgeons to agree,” Dr. Tracey Dechert, a trauma surgeon at Boston Medical, said. “Am I right here? This can’t be saved. So that way you feel better and know that you didn’t take off someone’s leg that you didn’t have to take. All rooms had multiple surgeons so everyone could feel like we’re doing what we need to be doing.”