title: Health-related quality of life in patients with transtibial amputation and reconstruction with bone bridging of the distal tibia and fibula.
abstract: BACKGROUND
  Bone-bridging (arthrodesis of the distal tibia and fibula) at the time of transtibial amputation is a controversial operative technique that is anecdotally reported to improve the weightbearing capacity of the residual limb and to decrease residual limb discomfort.
  
  
  METHODS
  Thirty-two consecutive patients with multiple diagnoses had transtibial amputation with a distal tibial-fibular bone-bridge, all done by a single surgeon (MAP). At an average of 16.3 months after surgery all patients completed the Prosthetics Evaluation Questionnaire (PEQ), a validated outcomes instrument specifically created to evaluate quality of life and functional demands in patients with a lower extremity amputations. Their responses were compared with those of 17 preselected, highly functional transtibial amputees from two academic medical centers who previously had transtibial amputations using a traditional non bone-bridge operative technique; their time since amputation averaged 14.7 years.
  
  
  RESULTS
  The "nonselected" consecutive patients with a bone-bridged residual limb scored higher (more favorable) in the Ambulation (p = 0.037) and Frustration (p < 0.001) domains of the PEQ and lower (less favorable) in the Appearance (p = 0.025) subscale. Their scores were similar in the other six domains.
  
  
  CONCLUSIONS
  Patients of multiple ages with multiple diagnoses who had bone-bridging of the distal tibia and fibula at the time of transtibial amputation had scores on a validated outcomes instrument that were better than or comparable to those of a selected group of highly functional transtibial amputees. The results of this study suggest that bone-bridging at the time of transtibial amputation may enhance patient-perceived functional outcomes.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153, USA. mpinzu@lumc.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pinzur
authors.forename: Marco A Guedes S
authors.initials: MA
authors.lastname: Pinto
authors.forename: Matthew
authors.initials: M
authors.lastname: Saltzman
authors.forename: Fabio
authors.initials: F
authors.lastname: Batista
authors.forename: Frank
authors.initials: F
authors.lastname: Gottschalk
authors.forename: Dainius
authors.initials: D
authors.lastname: Juknelis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000674:Amputees / Q000523:psychology; D001174:Arthrodesis; D001186:Artificial Limbs; D003627:Data Interpretation, Statistical; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D005639:Frustration; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking