Below-knee amputation with a vascularized fibular graft and headless compression screw

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Below-knee amputations can result in free rotation and translation of the distal tibia and fibula.
• This instability limits effective torque transmission to the prosthesis.
• Current prosthetic designs may be restricted by the anatomy of the residual limb.

Purpose of the Study:

• To describe a surgical technique for distal tibiofibular bridging (Ertl modification) in below-knee amputation.
• To detail the use of a vascularized fibular segment and a headless compression screw in this procedure.
• To highlight the benefits of improved torque transmission and prosthetic versatility.

Main Methods:

• Surgical technique involving the Ertl modification for below-knee amputation.
• Utilizing a segment of vascularized fibula to create a bone bridge between the tibia and fibula.
• Employing a headless compression screw for stable fixation of the fibular segment.

Main Results:

• The Ertl modification establishes a bone bridge, enhancing stability of the distal tibia and fibula.
• This anatomical modification facilitates improved transmission of torque from the femur to the prosthesis.
• The technique allows for increased distal weight bearing and supports more versatile prosthetic designs.

Conclusions:

• Distal tibiofibular bridging via the Ertl modification offers significant biomechanical advantages for below-knee amputees.
• The described technique using a vascularized fibular segment and compression screw provides a stable and effective solution.
• This surgical approach can lead to improved prosthetic function and patient outcomes.