title: The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence.
abstract: BACKGROUND
  This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature.
  
  
  METHODS
  Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent.
  
  
  RESULTS
  Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic.
  
  
  CONCLUSIONS
  There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique.
  
  
  CONCLUSIONS
  Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.
authors.affiliation: 1 School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.|2 OP Solutions, Tampa, FL, USA.|3 Prosthesis Design + Research, Tampa, FL, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Kahle
authors.affiliation: 1 School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.|4 James A. Haley Veterans' Hospital, Tampa, FL, USA.|5 Research and Surveillance, Extremity Trauma and Amputation Center of Excellence, Tampa, FL, USA.
authors.forename: M Jason
authors.initials: MJ
authors.lastname: Highsmith
authors.affiliation: 6 Kenney Orthopedics, Lexington, KY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kenney
authors.affiliation: 6 Kenney Orthopedics, Lexington, KY, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Ruth
authors.affiliation: 7 Clinical Research of West Florida, Inc., Tampa, FL, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lunseth
authors.affiliation: 8 Department of Orthopaedic Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA.
authors.forename: Janos
authors.initials: J
authors.lastname: Ertl
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D001186:Artificial Limbs; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D013977:Tibia / Q000601:surgery*
keywords: Prosthesis interface mechanics; biomechanics; orthopedic surgery; prosthesis; prosthesis design; surgical methods