Osteomyoplasty for Transtibial Amputation: A Case Report and Review of the Literature

Hussainy, Haydar A. J. Al; Goesling, Thomas; Datta, D.; Saleh, Michael

doi:10.1097/00008526-200401000-00003

Cited by 4 publications

(3 citation statements)

References 1 publication

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“…The stresses under a truncated bone with small diaphysis diameter, such as the fibula of patient M (Table 3), are less homogeneously distributed. To overcome this effect, Hussainy et al 17 described a bone bridge surgical technique, called osteomyoplasty, for TTA patients in which the tibia and fibula are attached at their distal end, which creates a ''combined'' bony diameter, thereby promoting pressure dispersion and reducing the risk for ulceration.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Patient-Specific Finite Element Analysis of Internal Stresses in the Soft Tissues of a Residual Limb: A New Tool for Prosthetic Fitting

et al. 2006

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Fitting of a prosthetic socket is a critical stage in the process of rehabilitation of a trans-tibial amputation (TTA) patient, since a misfit may cause pressure ulcers or a deep tissue injury (DTI: necrosis of the muscle flap under intact skin) in the residual limb. To date, prosthetic fitting typically depends on the subjective skills of the prosthetist, and is not supported by biomedical instrumentation that allows evaluation of the quality of fitting. Specifically, no technology is presently available to provide real-time continuous information on the internal distribution of mechanical stresses in the residual limb during fitting of the prosthesis, or while using it and this severely limits patient evaluations. In this study, a simplified yet clinically oriented patient-specific finite element (FE) model of the residual limb was developed for real-time stress analysis. For this purpose we employed a custom-made FE code that continuously calculates internal stresses in the residual limb, based on boundary conditions acquired in real-time from force sensors, located at the limb-prosthesis interface. Validation of the modeling system was accomplished by means of a synthetic phantom of the residual limb, which allowed simultaneous measurements of interface pressures and internal stresses. Human studies were conducted subsequently in five TTA patients. The dimensions of bones and soft tissues were obtained from X-rays of the residual limb of each patient. An indentation test was performed in order to obtain the effective elastic modulus of the soft tissues of the residual limb. Seven force sensors were placed between the residual limb and the prosthetic liner, and subjects walked on a treadmill during analysis. Generally, stresses under the shinbones were approximately threefold higher than stresses at the soft tissues behind the bones. Usage of a thigh corset decreased the stresses in the residual limb during gait by approximately 80%. Also, the stresses calculated during the trial of a subject who complained about pain and discomfort were the highest, confirming that his socket was not adequately fitted. We conclude that real-time patient-specific FE analysis of internal stresses in deep soft tissues of the residual limb in TTA patients is feasible. This method is promising for improving the fitting of prostheses in the clinical setting and for protecting the residual limb from pressure ulcers and DTI.

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Section: Discussionmentioning

confidence: 99%

Real-Time Patient-Specific Finite Element Analysis of Internal Stresses in the Soft Tissues of a Residual Limb: A New Tool for Prosthetic Fitting

et al. 2006

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“…6 To stabilize the anatomic structures within the distal-most residual limb, the surgeon creates a synostosis between the tibia and fibula, a "bone bridge." 7 The bone bridge is created by using osteoperiosteal flaps as the foundation for osseous regeneration. The bridge can be augmented by using a portion of the fibula and supplementing the synostosis with cancellous bone graft ( Figure 2, personal file).…”

Section: Osteomyoplastic Surgical Proceduresmentioning

confidence: 99%

“…6 The myoplasty then provides the distal-most muscles within the anterior, superficial posterior, and lateral compartments attachment to one another, creating muscle-bone balance and stability within the residual limb. 7 The procedure creates a long, dynamic, cylindrical limb with significant surface area, which can improve prosthetic suspension, fit, and use. The smooth contour of the limb aids in preventing localized skin breakdown because the potential for pressure points is reduced.…”

Section: Osteomyoplastic Surgical Proceduresmentioning

confidence: 99%

Rehabilitation for Those With Transtibial Osteomyoplastic Amputation

Dionne

Ertl

Day

2009

JPO Journal of Prosthetics and Orthotics

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Often encountered in traditional transtibial amputation is a condition that constitutes pain, swelling, sense of instability, bone and soft tissue atrophy, and prosthetic difficulties, resulting in decreased function. One innovative method for maximizing the rehabilitation capability after amputation surgical reconstruction is osteomyoplastic transtibial amputation, commonly called the "Ertl procedure" (Ertl and Ertl, Prosthetics and Patient Management: A Comprehensive Clinical Approach. 2006). A standard for physical therapy management of those with osteomyoplastic transtibial amputation needs to be described for future controlled study. To describe the typical clinical presentation and current physical therapy management practiced in patients with osteomyoplastic transtibial amputation. Standardized physical therapy management of primary and secondary osteomyoplastic transtibial amputation from initial status through discharge is described. During the rehabilitation process after the Ertl procedure, residual limb compression hose is usually not applied. Progressive residual limb end bearing is encouraged. Muscle hypertrophy of all residual limb muscles because of strengthening exercise can occur, thus permanent prosthesis use may be delayed. Patient goals for normal gait and return-to-previous function can be achieved. Patients, who undergo an osteomyoplastic transtibial procedure, the Ertl procedure, may benefit from standardized physical therapy management guidelines to facilitate recovery time and maximize function. Setting a standard for care will allow outcomes to be measured and generalized more broadly, allowing future study of the effectiveness of care for patients with transtibial Ertl procedure. (J Prosthet Orthot. 2009;21:64 -70.)

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Assessment of Pressures Within the Prosthetic Socket of a Person With Osteomyoplastic Amputation During Varied Walking Tasks

Commuri

Day

Dionne

et al. 2010

JPO Journal of Prosthetics and Orthotics

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Osteomyoplasty for Transtibial Amputation: A Case Report and Review of the Literature

Cited by 4 publications

References 1 publication

Real-Time Patient-Specific Finite Element Analysis of Internal Stresses in the Soft Tissues of a Residual Limb: A New Tool for Prosthetic Fitting

Real-Time Patient-Specific Finite Element Analysis of Internal Stresses in the Soft Tissues of a Residual Limb: A New Tool for Prosthetic Fitting

Rehabilitation for Those With Transtibial Osteomyoplastic Amputation

Assessment of Pressures Within the Prosthetic Socket of a Person With Osteomyoplastic Amputation During Varied Walking Tasks

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