Ertl Amputation, Institute for Limb Preservation

The Ertl procedure is a below knee amputation technique where a bone bridge is formed between the tibia and fibula after the leg has been amputated. The surgeon amputates the leg and uses a portion of the fibula from the amputated leg to form the “bridge”.

The history of the Ertl procedure goes back to 1920 when Professor Janos Ertl, Sr., MD, of Hungary, developed the procedure to return a high number of amputees to the work force. Dr. Ertl noticed that a number of months after an amputation there was a natural tendency for the cut end of the tibia to grow towards the cut end of the fibula. Dr. Ertl thought it would be beneficial to assist this natural phenomenon by aiding in the bone growth between the cut end of the tibia and fibula.

The benefit of this bridge is it help to create a better load bearing area at the end of the residual limb. There is also the benefit of a better shape to the end of the limb, being less cone shaped than a non-Ertl procedure. In addition to the bridge, the technique for managing the muscles of the residual limb is a bit different from a traditional transtibial amputation. With the Ertl technique the muscles are sutured front-to-back and side-to-side whereas in a transtibial amputation the residual muscles are allowed to retract over time.

The theory that the Ertl provides a better shaped residual limb is why it is considered for some amputees.

X-ray of Bone Bridge Between Tibia and Fibula

Xray showing bone bridge between tibia and fibula

Read a case study of an Ertl procedure