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 ti… Show more
“…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.…”
“…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.…”
“…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].…”
Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl’s technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18–41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783–785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands.
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