TITLE

Operative Complications of Combat-Related Transtibial Amputations: A Comparison of the Modified Burgess and Modified Ertl Tibiofibular Synostôsis Techniques

AUTHOR(S)
Tintle, Scott M.; Keeling, John J.; Forsberg, Jonathan A.; Shawen, Scott B.; Andersen, Romney C.; Potter, Benjamin K.
PUB. DATE
June 2011
SOURCE
Journal of Bone & Joint Surgery, American Volume;6/1/2011, Vol. 93-A Issue 11, p1016
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The complications of bone-bridging amputations remain ill defined. The purpose of this study was to compare the early and intermediate-term complications leading to reoperation between the modified Burgess and modified ErtI tibiofibular synostosis in combat-related transtibial amputations. Methods: We conducted a retrospective review of consecutive, contemporaneous cohorts of thirty-seven modified ErtI bone-bridge and 100 modified Burgess combat-related transtibial amputations. The primary outcome measure was the need for reoperation following definitive closure. Results: At a mean follow-up of two years (range, nine to forty-eight months), there was a 53% overall reoperation rate. The overall complications included infection (34%), neuroma excision (18%), heterotopic ossification excision (15%), myodesis failure (4%), and scar revision (7%). A significantly higher rate of overall complications (p = 0.008) was noted in the bone-bridge group. Additionally, there was an increased rate of noninfectious complications in the bone-bridge group (p = 0.02). A positive selection bias was also noted for performing bone-bridge amputations late (p = 0.0002) and outside the zone of injury (p < 0.0001). Bone-bridge-specific complications occurred in 32% of the modified ErtI group. Delayed union or nonunion of the synostosis (11%) and implant-related complications (27%) predominated. Three bone bridges were ultimately removed. Conclusions: Reoperations were needed at a significantly greater rate overall and for noninfectious complications following bone-bridge synostosis compared with modified Burgess transtibial amputations. Additionally, despite the positive selection bias favoring the bridge synostosis cohort, infection rates were not lower in that group. Detailed patient counseling and careful patient selection are indicated prior to performing modified ErtI amputations, particularly in the absence of convincing evidence regarding objective functional benefits from the procedure.
ACCESSION #
62548320

 

Related Articles

  • Neuroma Coding. Murphey, Matt; Pedowitz, Walter // Podiatry Management;Sep2011, Vol. 30 Issue 7, p30 

    A letter to the editor is presented which is concerned with the billing code which podiatrists should use for the excision of a neuroma.

  • Are laboratory-based antibiograms reliable to guide the selection of empirical antimicrobial treatment in patients with hospital-acquired infections? Carlos Bantar; Gabriela Alcazar; Diego Franco; Francisco Salamone; Eduardo Vesco; Teodoro Stieben; Florencia Obaid; Alejandro Fiorillo; Mariano Izaguirre; María Eugenia Oliva // Journal of Antimicrobial Chemotherapy (JAC);Jan2007, Vol. 59 Issue 1, p140 

    Objectives: Antibiograms are often taken into account to define a rational selection of an empirical antimicrobial therapy for treating patients with hospital-acquired infections. In this study, we performed a paired comparison between the antibiogram constructed with laboratory-based data and...

  • Neuroma Pain. Lisch, Randy; Smith, Doug; Sullivan, Tip; Katz, Marc; Scartozzi, Gino // Podiatry Management;Sep2011, Vol. 30 Issue 7, p24 

    A letter to the editor is presented which is concerned with a podiatry patient who had continuous pain following the removal of a neuroma from his foot.

  • Stump Neuroma. Lagman, Robert; Pedowitz, Walter // Podiatry Management;Mar2011, Vol. 30 Issue 3, p14 

    The article provides an answer to the question on the correct medical code for a resection of a stump neuroma.

  • OPERATIVE TREATMENT OF INTERDIGITAL NEUROMA. Coughlin, MIchael J.; Pinsonneault, Troy // Journal of Bone & Joint Surgery, American Volume;Sep2001, Vol. 83-A Issue 9, p1321 

    Background: The literature regarding the outcome of surgical treatment of interdigital neuroma is incomplete. The purpose of this study was to assess the demographics associated with the presentation of an interdigital neuroma as well as the long-term clinical results of operative resection by a...

  • Acoustic neuroma surgery and tinnitus. Fahy, Colm; Nikolopoulos, Thomas P.; O'Donoghue, Gerard M. // European Archives of Oto-Rhino-Laryngology;Jul2002, Vol. 259 Issue 6, p299 

    The objectives of this study were to assess the effect that acoustic neuroma surgery has on tinnitus and to investigate possible predictors (tumour size and patients' ages at operation) as well as to ascertain if the overall quality of life in patients with acoustic neuromas is affected by their...

  • Post-op Maggots. Burrell, Neil A.; Ortiz, Jr., Narmo L.; Adamov, Donald J. // Podiatry Management;Oct2010, Vol. 29 Issue 8, p24 

    A letter to the editor is presented which is concerned with a patient who had maggots develop at a surgical site.

  • PM JURY VERDICT REPORTER.  // Podiatry Management;Sep2005, Vol. 24 Issue 7, p39 

    Presents a court case on alleged negligent nueroma surgery in the District of Columbia. Incidents that led to the case; Decision of the jury in the case; Injuries brought about by the alleged negligence.

  • Long-term effects of vestibular compensation on balance control and sensory organisation after unilateral deafferentation due to vestibular schwannoma surgery. Cécile Parietti-Winkler // Journal of Neurology, Neurosurgery & Psychiatry;Aug2010, Vol. 81 Issue 8, p934 

    The time-course of central adaptive mechanisms after vestibular schwannoma surgical removal allows, 3 months after surgery (middle term), a satisfactory recovery of balance control. However, the long-term evolution of postural control beyond the end of usual medical follow-up remains unknown....

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics