New Article on Ertl Variant
The most recent issue of Prosthetics & Orthotics International includes a number of very interesting and clinically relevant articles. One noteworthy example is a report from Brazil on a series of fifteen transtibial amputations, performed from 1997-2003, that used a fibular strut graft to create a bone bridge. Marco Guedes and his colleague described their method, which is based on the Ertl concept but uses a section of fibula that is dovetailed into the tibia. About half of the cases were revision surgeries and about half were primary amputations.
In their experience, the fib strut method resulted in a residuum that could be fitted an average of three months post-operatively, which is similar to their results with an amputation that does not include the bone bridge. One patient required a revision plus bone grafting and another had a wound dehiscence that delayed healing for six months, but all bridges ultimately solidified by approximately one year post-operatively.
They commented favorably on the increased ability for distal end bearing that the bone bridge offered although no formal outcomes measurements were reported. The limitations noted included the need for sufficient circulation to heal this more extensive procedure, the necessity to shorten the residuum in most cases, and a tendency for blister formation in the early post-op period, which they felt was due to the skin flap mobilization that is required.
This is one of the few peer-reviewed articles on the Ertl procedure and related variants. Congratulations are due to the authors for adding to our understanding by reporting their experiences. [Pinto MAGS, Harris WW. Fibular segment bone bridging in trans-tibial amputation. POI 2004; 28(30) 220-224].
