title: A comparison of limb-socket kinematics of bone-bridging and non-bone-bridging wartime transtibial amputations.
abstract: BACKGROUND
  While there are proponents of both bone-bridging and non-bone-bridging transtibial amputation techniques, there is a lack of evidence describing functional differences between these two techniques. The goal of the present investigation was to objectively compare the techniques of bone-bridging and non-bone-bridging with respect to limb socket displacement during physiologic loading.
  
  
  METHODS
  Fifteen male subjects with an average age of twenty-seven years (range, twenty-two to thirty-two years) who had undergone a unilateral transtibial amputation secondary to a traumatic wartime injury were prospectively evaluated. Seven patients had undergone a bone-bridging amputation, and eight had undergone a non-bone-bridging amputation. Digital fluoroscopic video was used to measure the vertical displacement of the limb within a total-surface-bearing socket with weight-bearing from 0% to 100% of body weight.
  
  
  RESULTS
  There was no difference in limb-socket displacement between amputation techniques with initial loading (12.78 mm for the bone-bridging group, compared with 12.43 mm for the non-bone-bridging group; p = 0.88) or with total loading (p = 0.98). Similarly, there was no difference between suspension mechanisms in limb-socket displacement with initial loading (12.15 mm for patients with pin lock suspension, compared with 12.98 mm for those with suction sleeve suspension; p = 0.72) or with total loading (18.24 mm for patients with pin lock suspension, compared with 21.42 mm for those with suction sleeve suspension, p = 0.21).
  
  
  CONCLUSIONS
  The current study demonstrated no difference between surgical techniques with respect to bone-socket displacement. These data provide no evidence to support statements that bone-bridging contributes to a more efficient platform in the total-surface-bearing socket.
authors.affiliation: Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, 3851 Rogers Brooke Drive, Fort Sam Houston, TX 78234, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Tucker
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wilken
authors.forename: P Daniel J
authors.initials: PD
authors.lastname: Stinner
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kirk
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods*; D001753:Blast Injuries / Q000601:surgery*; D005471:Fluoroscopy; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008889:Military Personnel; D011183:Postoperative Complications; D011446:Prospective Studies; D013524:Surgical Flaps; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D014857:Warfare