Symptomatic distal tibiofibular instability is a known complication of
trauma-related transtibial
amputations. Overt proximal tibiofibular dislocations, which are easily recognized on routine radiographs, may occur concurrently with the traumatic injury or
amputation. More commonly, however, the proximal tibiofibular joint remains structurally intact in the presence of distal instability due to the loss of the distal syndesmotic structures and damage to the interosseous membrane, resulting in fibular angulation and distal tibiofibular diastasis. Some authors have espoused treating this instability with the creation of a distal tibiofibular bridge
synostosis (the so-called Ertl procedure or modifications there of) to prevent potentially painful discordant motion and to minimize the prominence of the residual distal fibula. Recent studies, however, have suggested an increase in complication and reoperation rates in transtibial
amputations that received a bridge
synostosis compared with standard transtibial
amputations. Additionally, although there are several described techniques for bridge
synostosis creation, most are dependent on having sufficient remaining fibula to construct the bone bridge without unnecessary shortening of the tibia; however, sufficient residual fibula is not always available after traumatic and
trauma-related
amputations. We propose a technique utilizing a
suture bridge to restore tibiofibular stability when performing transtibial
amputations in patients with proximal tibiofibular dislocations or distal diastasis, avoiding the potential need for a distal bridge
synostosis.