Original Article

Transtibial Amputation With Fibulectomy and Fibular Collateral Ligament-Biceps Reconstruction: Surgical Technique and Clinical Experience

Harrington, Colin J. MD^a; Kaplan, Shane A. MD^a; Richards, John T. MD^a; Smith, Douglas G. MD^b; Souza, Jason M. MD^c; Potter, Benjamin K. MD^a,d

Author Information

^aDepartment of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD;

^bThe Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD;

^cDepartments of Plastic and Reconstructive Surgery and Orthopedic Surgery, The Ohio State University, Columbus, OH; and

^dUniformed Services University, Walter Reed Department of Surgery, Bethesda, MD.

Reprints: Benjamin K. Potter, MD, Uniformed Services University, Walter Reed Department of Surgery, 4301 Jones Bridge Rd, Bethesda, MD 20814 (e-mail: [email protected])

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Journal of Orthopaedic Trauma 37(6):p 299-303, June 2023. | DOI: 10.1097/BOT.0000000000002570

Abstract

Objectives:

To describe our clinical experience and surgical technique of transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction for management of, particularly short, transtibial amputations with proximal fibula prominence, overt instability, or inadequate soft-tissue coverage.

Design:

Retrospective review.

Setting:

Level II trauma center.

Patients:

Twelve consecutive patients who underwent transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction between 2008 and 2021.

Intervention:

We reviewed patient medical records, radiographs, and clinical photographs.

Main Outcome Measurements:

Complications, instability, and pain.

Results:

Eight patients underwent acute transtibial amputation with fibulectomy and reconstruction, whereas 4 patients underwent amputation revision with fibulectomy and reconstruction for chronic pain. All 12 patients were men, with a median age of 39 years (interquartile range, 33–46). All injuries were due to high-energy mechanisms, including improvised explosive device (n = 8), rocket-propelled grenade (n = 2), gunshot wound (n = 1), and motor vehicle accident (n = 1). After a median follow-up of 8.5 years (interquartile range, 3.4–9.3), there was one complication, a postoperative suture abscess. No patients had subjective lateral knee instability after the procedure, and the average pain scores decreased from 4.75 to 1.54 (P = 0.01). All patients returned to regular prosthesis wear and maintained independent functioning with activities of daily living.

Conclusions:

Our experience with fibulectomy and fibular collateral ligament-biceps reconstruction demonstrated no subjective or clinical postoperative instability and may be a useful adjunct for managing transtibial amputations with fibular instability or prominence, pain, or skin breakdown at the fibular head.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Transtibial Amputation With Fibulectomy and Fibular Collateral Ligament-Biceps Reconstruction: Surgical Technique and Clinical Experience