From the Department of Scientific, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
J Am Acad Orthop Surg Glob Res Rev. 2024 Aug 19;8(8). doi: 10.5435/JAAOSGlobal-D-24-00063. eCollection 2024 Aug 1.
We present a case report of synostosis after transtibial amputation because of distraction regenerate formation after decortication of the lateral surfaces of the tibia and fibula, sequential compression, and distraction using the Ilizarov apparatus. Its advantage is that there is no need to shorten bone. The establishment of distal tibia-fibula synostosis (Ertl) in patients with transtibial amputation has been advocated to improve function and prosthetic wear. There are a variety of techniques to create a bone block. This case reports the successful use of an innovative technique to establish bone block. A patient with transtibial amputation underwent revision of residual limb by decorticating the lateral aspect of the distal tibia and the medial aspect of the distal fibula and acutely compressing the distal ends of the 2 bones with the Ilizarov apparatus. The distal fibula is then slowly and progressively distracted laterally, and the bone is formed in the space between the distal fibula and tibia, creating synostosis with an increased distal bone cross-sectional surface area for improved function and prosthetic wear. The follow-up period was 24 months. Within 3 months, synostosis was formed, which increased the area of the supporting surface and allowed temporary and then permanent prosthetics. After 24 months, synostosis did not differ from the structure of tibial stump bones.
我们报告了一例胫骨经皮骨切除术、外侧骨皮质切除、序贯压缩、伊利扎洛夫装置牵张再生后发生胫骨和腓骨融合的病例。其优点是不需要缩短骨骼。在胫骨截肢患者中建立远端胫骨 - 腓骨融合（Ertl）可改善功能和假体磨损。有多种技术可以创建骨块。本病例报告了一种成功使用创新技术建立骨块的方法。一名胫骨截肢患者接受了残肢修复，通过对胫骨远端外侧和腓骨远端内侧进行骨皮质切除术，并使用伊利扎洛夫装置急性压缩 2 根骨头的远端，随后将腓骨缓慢而逐渐地向外侧牵张，在腓骨远端和胫骨之间形成骨，增加了远端骨的横截面积，从而改善了功能和假体磨损。随访时间为 24 个月。3 个月内形成了骨融合，增加了支撑面的面积，并允许暂时和永久性假肢的使用。24 个月后，骨融合与胫骨残端骨的结构没有区别。
