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J Orthop Trauma. 2017 Apr;31 Suppl 1:S63-S69. doi: 10.1097/BOT.0000000000000791.

Transtibial Amputation Outcomes Study (TAOS): Comparing Transtibial Amputation With and Without a Tibiofibular Synostosis (Ertl) Procedure.

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*Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, University of San Francisco; ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; §Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma; ‖Department of Orthopaedic Surgery, Naval Medical Center San Diego; ¶Harborview Medical Center, University of Washington; **Department of Orthopaedic Surgery, Wake Forest Baptist Health; ††Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health; and ‡‡Orthopaedic Trauma Service, Tampa General Hospital, Florida Orthopaedic Institute.


The optimal technique for a transtibial amputation in a young, active, and healthy patient is controversial. Proponents of the Ertl procedure (in which the cut ends of the tibia and fibula are joined with a bone bridge synostosis) argue that the residual limb is more stable which confers better prosthetic fit and improved function especially among high-performing individuals. At the same time, the Ertl procedure is associated with longer operative and healing time and may be associated with a higher complication rate compared with the standard Burgess procedure. The TAOS is a prospective, multicenter randomized trial comparing 18-month outcomes after transtibial amputation using the Ertl versus Burgess approach among adults aged 18 to 60. The primary outcomes include surgical treatment for a complication and patient-reported function. Secondary outcomes include physical impairment, pain, and treatment cost.

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