Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jun 22:16:171-178.
doi: 10.2147/ORR.S459421. eCollection 2024.

Modification of Ertl Operation for Short Stump

Viktor Ivanovych Shevchuk  1 , Yurii Bezsmertnyi  1 , Olexander Yuriyovych Bezsmertnyi  1 , Olexander Yuriyovych Branitsky  1
Affiliations
Case Reports

Modification of Ertl Operation for Short Stump

Viktor Ivanovych Shevchuk et al. Orthop Res Rev. .

Abstract

Background: Despite a sufficient number of papers on the technique of transtibial amputations, the technique of Ertl-type reamputation in short tibial stump remains unreported.

Aim: To propose a modification of the Ertl operation in the proximal tibia.

Case presentation: The technique of bone bridge creation in a patient with a malformed stump in the upper third of the tibia at the expense of the regenerate formed after corticotomy of the tibial remnant and dosed distraction of the graft by the Ilizarov apparatus is described. Radiological, ultrasound and MRI methods were used to control the regenerate. The follow-up period was 36 months. At 3.5 months, a synostosis was formed, which allowed primary and then permanent prosthesis with a full-contact prosthesis. At 36 months, the organotypic remodelling of the regenerate was completed. The patient works, uses the prosthesis for 15-16 hours a day, and walks on average 8-10 km.

Conclusion: The use of the proposed method makes it possible to obtain tibial synostosis without their shortening with elimination of valgus deviation of the fibula stump and the possibility of early functional loading. Synostosis formation occurs within 3.5 months after surgery. Organotypic bone remodelling occurs during primary and then permanent prosthetics. The formed bone bridge has a large support area, which is maintained during the whole follow-up period of 36 months and allows to perform full-contact prosthetics with maximum load on the residual limb end.

Keywords: Ertl reamputation; distraction; prosthesis; regeneration.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic diagram of the operation.
Figure 2
Figure 2
Patient with functional load device (15.02.2020).
Figure 3
Figure 3
Radiographs of the residual limb in 2 projections 3 months after surgery (17.05.2020).
Figure 4
Figure 4
Radiographs of the residual limb 3 years after amputation (20.05.2023).
See this image and copyright information in PMC

References

    1. Burgess EM, Romano RL, Zettl JH, Schrock RD Jr. Amputations of the leg for peripheral vascular insufficiency. J Bone Joint Surg Am. 1971;53(5):874–890. [PMID: 4934074]. doi:10.2106/00004623-197153050-00003 - DOI - PubMed
    1. Taylor BC, Poka A. Osteomyoplastic transtibial amputation: the Ertl technique. J Am Acad Orthop Surg. 2016;24(4):259–265. PMID: 26881327. doi:10.5435/JAAOS-D-15-00026. - DOI - PubMed
    1. Felder JM 3rd, Skladman R. Translating technique into outcomes in amputation surgeries. Mo Med. 2021;118(2):141–146. [PMID: 33840857; PMCID: PMC8029626]. doi:10.1016/j.apmr.2007.11.005 - DOI - PMC - PubMed
    1. Pinzur MS, Beck J, Himes R, Callaci J. Distal tibiofibular bone-bridging in transtibial amputation. J Bone Joint Surg Am. 2008;90(12):2682–2687. PMID: 19047714; PMCID: PMC3076214. doi:10.2106/JBJS.G.01593. - DOI - PMC - PubMed
    1. Chang BL, Kleiber GM. Evolution of amputee care. Orthop Surg. 2023;12:1–14. ISSN 2666-769X. doi:10.1016/j.orthop.2023.05.001. - DOI

Publication types