Abstract

Appositional or terminal overgrowth of bone is common in children with an acquired or congenital amputation. This problem is seen primarily after amputation through the diaphysis of the tibia. Management of this condition requires frequent prosthetic adjustments or operative revision of the limb. [1].

Fusion of the distal tibia and fibula in transtibial amputations was first described in the early 20th century by Janos Ertl in Hungary. The concept was later popularized in the United States by Col.

Philip A. Deffer in the 1960s and multiple modifications of the original technique have since been described [2].

We concentrate on painless rounded functional residual limbs & end weight bearing capability. So, we use Ertl’s procedure to evaluate the effect of this procedure on termination of overgrowth of bone in two children, one diagnosed as bilateral tibia hemimelia and the other as bilateral vascular insufficiency both underwent bilateral transtibial amputation following that technique.

After reviewing the literature regarding that technique, our hospital is first in applying the modified Ertl’s procedure in pediatric patients who need bilateral transtibial amputation due to pathological limbs.

Keywords: Tibiofibular bridge synostosis; Transtibial amputation; Modified ertl’s procedure; Overgrowth