The use of bone bridges in transtibial amputations

Abstract

We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments.Results: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations.Conclusions: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

Transtibial Ertl amputation for children and adolescents: A case series and literature review

“…The Ertl procedure has a number of potential advantages over a traditional trans-tibial amputation. It promotes the maintenance of tissue with better sensation, proprioception, and blood flow, potentially resulting in improved end weight bearing and less pain, with more hours of functional prosthetic use [14, 15]. Ertl [4] described a procedure that resulted in a bony synostosis between the distal weight bearing ends of the tibia and fibula through the construction of an osteoperiosteal tunnel between the distal ends of transected long bones, using local or distant cancellous bone graft to fill the periosteal tunnel.…”

Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients

“…The original technique involved the preparation of a periosteum cylinder that was extracted from the tibia with attached bone fragments, which promoted tibiofibular synostosis at the distal extremity of the amputation stump. A major problem with this technique was that it is not always possible to achieve bony bridge formation [5]. Subsequently, variations of the bony bridge have been described [6, 7].…”