The Journal of Bone and Joint Surgery (American). 2008;90:2682-2687.
doi:10.2106/JBJS.G.01593
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Distal Tibiofibular Bone-Bridging in Transtibial Amputation

Michael S. Pinzur, MD1, Jennifer Beck, MD1, Ryan Himes, BS1 and John Callaci, PhD1

1 Department of Orthopaedic Surgery, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153. E-mail address for M.S. Pinzur: mpinzu1{at}lumc.edu. E-mail address for J. Beck: jbeck{at}lumc.edu

Investigation performed at Loyola University Health System, Maywood, Illinois

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation.

Methods: Twenty consecutive patients who underwent a unilateral transtibial amputation, as a consequence of traumatic injury, had distal tibiofibular bone-bridging performed by a single surgeon. Eight completed the Prosthesis Evaluation Questionnaire (PEQ), a validated outcomes instrument designed to measure patient self-reported health-related quality of life after a lower-extremity amputation. Their responses were compared with those of a previously reported control group of nondiabetic patients who had undergone transtibial amputation with the use of a traditional technique and with those of a previously reported consecutive group of Brazilian patients, including twelve who were diabetic, who had undergone a similar bone-bridge procedure.

Results: The scores in the American bone-bridge group were similar to those in the control group and not as good as those in the Brazilian bone-bridge group. The American bone-bridge and control groups scored lower in the Social Burden, Ambulation, Frustration, Sounds, Utility, and Well-Being domains of the PEQ.

Conclusions: While many experts in the care of amputees believe that the distal tibiofibular bone-bridge technique improves patient functional outcomes, our small group of patients treated with this procedure did not appear to have better outcomes than a group of patients treated successfully with a standard surgical technique. More information is needed before the bone-bridge technique can be recommended as an important component of standard transtibial amputation surgery.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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