Below-Knee Amputation with a Vascularized Fibular Graft and Headless Compression Screw

Distal tibiofibular bridging (Ertl modification) in a below-knee amputation can provide an improved transmission of torque from the distal femur to the prosthesis. Without this bridge, the distal tibia and fibula are left freely rotating and translating in the soft-tissue envelope. The distal fibular segment creates a bone bridge that allows for increased distal weight bearing and more versatile prosthetic design. The purpose of this article is to describe the authors' technique for performing the Ertl modification to the below-knee amputation using a segment of vascularized fibula and a headless compression screw.