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Area of Science:

  • Orthopedic surgery
  • Regenerative medicine
  • Biomechanical engineering

Background:

  • Transtibial amputation presents challenges for prosthetic fitting and function.
  • Distal tibia-fibula synostosis (Ertl procedure) is a technique to improve residual limb characteristics.
  • Existing methods for creating synostosis may require bone shortening.

Purpose of the Study:

  • To report a case of successful distal tibia-fibula synostosis using an innovative distraction regenerate technique.
  • To evaluate the efficacy of this method in improving residual limb surface area for prosthetic wear.
  • To demonstrate a bone-lengthening approach to synostosis creation.

Main Methods:

  • A transtibial amputation patient underwent residual limb revision.
  • Decortication of the distal tibia and fibula was performed.
  • The Ilizarov apparatus was used for acute compression and subsequent gradual distraction to form a bone regenerate (synostosis).

Main Results:

  • Synostosis formation was achieved within 3 months post-operatively.
  • The procedure increased the distal bone cross-sectional surface area.
  • Improved prosthetic support and wearability were observed, with no adverse changes at 24-month follow-up.

Conclusions:

  • This innovative technique successfully created distal tibia-fibula synostosis in a transtibial amputation case.
  • The method offers a viable alternative for improving residual limb anatomy and prosthetic integration.
  • The distraction regenerate approach provides enhanced bone surface area without bone shortening.