The Portsmouth Modification of the Ertl Bone-Bridge Transtibial Amputation: The Challenge of Returning Amputees Back to Active Duty

In the military setting, severe lower-extremity trauma is an unfortunate but not uncommon result of armed conflict. Newer body armor has lead to an increase in survival as a result of the protection afforded the head, abdomen, and thorax. However, the extremities are still relatively unprotected, resulting in an increase in individuals surviving with limb trauma. The thought that an amputee will be permanently handicapped has been challenged by many military members with several remaining on active duty as fully operational soldiers and sailors. The purpose of this article is to describe our technique of transtibial amputation using a bone bridge between the tibia and fibula (a modified Ertl procedure). This procedure produces a residual limb with increased surface area, cylindrical alignment, stable syndesmosis, and decreased heterotopic ossification.