Improving function in transtibial amputation: the distal tibiofibular bone-bridge with Arthrex Tightrope fixation

The distal tibiofibular bone bridge for transtibial amputation is designed to allow for axial loading in a prosthesis, better proprioception of the residual limb, and less pain from tibiofibular instability. Originally described as an osteoperiosteal sleeve by Janos Ertl, Sr. in the early 20th century, it was later modified by Pinto and Harris to a fibular bone block technique. In this article, we describe a new technique for securing the fibular bone block. Use of the Tightrope (Arthrex, Naples, Florida) suture-button fixation system minimizes the chance of symptomatic hardware, prevents diastasis, and allows physiologic micromotion. In our experience, this procedure has been highly successful.