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Modification of Ertl Operation for Short Stump.

Viktor Ivanovych Shevchuk1, Yurii Bezsmertnyi1, Olexander Yuriyovych Bezsmertnyi1

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Summary

This study presents a modified Ertl operation for short tibial stumps, creating a bone bridge for improved prosthesis fitting. The technique allows early functional loading and long-term stability in transtibial amputations.

Keywords:
Ertl reamputationdistractionprosthesisregeneration

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Area of Science:

  • Orthopedic surgery
  • Regenerative medicine
  • Biomechanical engineering

Background:

  • Transtibial amputation techniques are well-documented, yet Ertl-type reamputation for short tibial stumps remains underexplored.
  • Existing methods may not adequately address stump malformation or prepare for optimal prosthetic integration.

Observation:

  • A modified Ertl operation was performed on a patient with a malformed proximal tibial stump.
  • Bone bridge creation utilized regenerate formed after corticotomy and distraction osteogenesis via the Ilizarov apparatus.
  • Radiological, ultrasound, and MRI methods monitored regenerate formation over a 36-month follow-up.

Findings:

  • Tibial synostosis formed within 3.5 months, enabling early prosthesis use.
  • Organotypic bone remodeling was complete by 36 months, ensuring long-term regenerate stability.
  • The resultant bone bridge provided a large, stable support area for full-contact prosthetics.

Implications:

  • This modified Ertl technique facilitates tibial synostosis without shortening, correcting fibular valgus deviation.
  • Early functional loading and prosthetic use are possible due to rapid synostosis and bone remodeling.
  • The method supports maximum load on the residual limb end, enhancing patient mobility and function.