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J Child Orthop. 2011 Oct;5(5):357-62. Epub 2011 Sep 6.

Transtibial Ertl amputation for children and adolescents: a case series and literature review.

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Department of Pediatric Orthopaedics, Children's Hospital of Eastern Ontario, Ottawa Hospital and the University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada.



Despite advances in limb reconstruction, there are still a number of young patients who require trans-tibial amputation. Amputation osteoplasty is a technique first described by Ertl to enhance rehabilitation after trans-tibial amputation. The purpose of the study reported here was to evaluate the results of the original Ertl procedure in skeletally immature patients and to assess whether use of this procedure would result in a diminished incidence of bony overgrowth.


The cases of four consecutive patients (five amputations) treated between January 2005 and June 2008 were reviewed. Clinical evaluation consisted of the completion of the prosthesis evaluation questionnaire (PEQ) and physical examination. Radiographic analysis was performed to evaluate bone-bridge healing, bone overgrowth, and the development of genu varum as measured by the medial proximal tibial angle (MPTA).


The best mean PEQ score in the question section was 91.8 (range 74-100) for 'well being' and the worst mean score was 66.6 (range 50-78) for 'residual limb health'. Examination of the residual limbs revealed no bursae, and all knees were stable with full range of movement. All bony bridges united at an average age of 1.7 (range 1-2) months. One case required stump revision for bony overgrowth, and one case developed asymptomatic mild genu varum.


The original Ertl osteomyoplasty may serve as one of the options for treatment of trans-tibial amputation in older children.


Our results suggest that the Ertl osteomyoplasty is a feasible option in this challenging patient population.


Child amputation; Ertl osteomyoplasty; Stump overgrowth

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