title: Distal tibiofibular bone-bridging in transtibial amputation.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, USA. mpinzu1@lumc.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pinzur
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beck
authors.forename: Ryan
authors.initials: R
authors.lastname: Himes
authors.forename: John
authors.initials: J
authors.lastname: Callaci
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000295:instrumentation*; D000672:Amputation Stumps / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult