title: Comparison of functional outcomes following bridge synostosis with non-bone-bridging transtibial combat-related amputations.
abstract: BACKGROUND
  The prevalence of penetrating wartime trauma to the extremities has increased in recent military conflicts. Substantial controversy remains in the orthopaedic and prosthetic literature regarding which surgical technique should be performed to obtain the most functional transtibial amputation. We compared self-reported functional outcomes associated with two surgical techniques for transtibial amputation: bridge synostosis (modified Ertl) and non-bone-bridging (modified Burgess).
  
  
  METHODS
  A review of the prospective military amputee database was performed to identify patients who had undergone transtibial amputation between June 2003 and December 2010 at three military institutions receiving the majority of casualties from the most recent military conflicts; two of those institutions, Walter Reed Army Medical Center and National Naval Medical Center, have since been consolidated. Short Form-36, Prosthesis Evaluation Questionnaire, and functional data questions were completed by twenty-seven modified Ertl and thirty-eight modified Burgess isolated transtibial amputees.
  
  
  RESULTS
  The average duration of follow-up after amputation (and standard deviation) was 32 ± 22.7 months, which was similar between groups. Residual limb length was significantly longer in the modified Ertl cohort by 2.5 cm (p < 0.005), and significantly more modified Ertl patients had delayed amputations (p < 0.005). There were no significant differences between groups with regard to any of the Short Form-36 domains or Prosthesis Evaluation Questionnaire subsections.
  
  
  CONCLUSIONS
  The modified Ertl and Burgess techniques offer similar functional outcomes in the young, active-duty military population managed with transtibial amputation.
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg. 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Keeling
authors.forename: Scott B
authors.initials: SB
authors.lastname: Shawen
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kirk
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
authors.forename: David E
authors.initials: DE
authors.lastname: Gwinn
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods*; D001186:Artificial Limbs; D005500:Follow-Up Studies; D006801:Humans; D007869:Leg Injuries / Q000209:etiology / Q000601:surgery*; D008297:Male; D008889:Military Personnel; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D057566:Self Report; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D014857:Warfare