July 1999 I made the decision to undergo transtibial amputation of my right foot. By a stroke of luck and a very unlikely connection, I was intercepted by Mr. Raymond Francis, the Chief Prosthetist chief prosthetist of Ohio Willow Wood.

He invited me to meet several active duty Navy Seals, one had the ERTL and the other did not. While both were very able bodied athletes and in the extreme physical condition of conditioning, it was easy to see that the one with the ERTL could be very aggressive physically without soreness or discomfort.

Of the eight years following my injury, I had spent the last three years tolerating of my eight years after the injury dealing with major pain issues i.e. nerve damage, mal union of the ankle and RSD, just to name a few of the problems I was experiencing. Prior to this, my work in the military demanded the highest in fitness and I enjoyed heavy physical activity and the ERTL amputation seemed the best way for me to return to my preferred lifestyle.I had the surgery at Portsmouth Naval Hospital by Dr. Dan Unger and since that time I have never looked back. I felt better by Day One and day one, by the sixth week I was walking without a cane for the, a first time in three years.  Within two months I was running again and feeling wonderful.

I have had a major change in my career field three years ago and I am now working in the prosthetic industry.  I have traveled the US, Mexico, Central and South America dealing with amputee issues, giving presentations to multidisciplinary seminars and Congresses.  I continue to be amazed at how often I hear that the ERTL/bone bridge does not really matter in amputations and has no real benefit to the amputee.  As someone from a flagship military hospital said ”that Colonel so and so doesn’t have an ERTL and runs so many miles.“  While I am sure this may be so, I would be willing to bet that given the same mile run, an ERTL amputee has less ”payback“ afterwards than the person with a standard amputation.  I am also amazed at the misinformation this same source gives to amputees who ask about the ERTL: ”You will have problems with the socket fit.  The ERTL is only for children and it is more painful in surgery and healing.“  These are just a few of the comments I remember.

I happened to be at this same military hospital to visit a young Marine that stepped on a landmine in Afghanistan and the above information was given to him when he asked about the ERTL.  The Marine was very lucky to have the same surgeon I had travel to this hospital to perform the ERTL/bridge. The hospital was so interested in learning or watching the technique they only sent a first year resident to observe.  No senior surgeons attended.

We see a large number of amputees in our facility and I save seen scores more throughout my travels as well.  Regardless of age or overall heath, the amputees without an ERTL are sensitive to end pressure and squeezing pressure of the tibia and fibula. Long term amputees grow more pointed and tapered and have more difficulties with socket fit.  Amputees with the ERTL, however, tend to have rounder, fuller, and broader distal ends, are able to bear more pressure distally, have no problems with any medial/lateral squeezing sensation and if the socket is fit correctly will have no problems in these areas either. Or as someone from a flagship military hospital said that Colonel so and so doesn’t have a ERTL and runs so many miles while I am sure this may be so but I would be willing to bet that given the same miles run, a ERTL amputee has less payback than the person without one.  From this same source I am amazed at the misinformation given to amputees that ask about the ERTL. You will have problems with the socket fit, the ERTL is only for children and it is a more painful in surgery and healing. This is just a few that I remember.

We are very lucky to have the influence and guidance of many incredible Orthopedic Surgeons, such as Doctors Jan Ertl, Marco Guedes, Dan Unger, Attila Poka, Joel Stewart, Claude Anderson and Scott Helmers, just to name a few. I happened to be at this hospital to visit a young Marine that stepped on a landmine in Afghanistan and the above information was given to him when he asked about the ERTL.  The Marine was very lucky to have the doctor I had for my surgery travel to this hospital to perform the ERTL/bridge, the hospital was so interested in learning or watching the technique they sent a first year resident to observe, no senior surgeons attended

As a foot note, the Line Marine reenlisted in the Corp, was promoted to Sergeant and in fact was recently honor graduate from the Army’s Fort Benning jump school out of three hundred plus students. All this he has accomplished as an amputee with a long and strong residual limb. I have traveled the US, Mexico, Central and South America dealing with amputee issues, giving presentations to multidisciplinary seminars and congresses and I am amazed how often I hear that the ERTL/bone bridge doesn’t really matter, and has no real benefit to the amputee.

I admit to being passionate about all of this because I see the results of both surgeries. I am confused by those who act like the ERTL procedure is brain surgery, when my friend the carpenter understands it and sees the benefit.  In the sound leg, the tibia and fibula are connected.  So why then should amputated bones not connect?  It’s like a door with a header: without the piece that connects the proximal portion of the door the door is weak; with it the door is much stronger.  The ERTL performs in the same manner.

I am able to use my limb to do many things others without the bridge cannot do. I can stabilize myself in the shower by placing my distal end in the soap dish or on even the slightest of ledges in the tub. When I get up in the morning and my shoe is further away than I can reach from my bed, I simply stand on my limb to give me the reach. As my limb is fairly long, I have great leverage in my socket and during volume changes I can settle down deeper and remain comfortable.

We see a large number of amputees in our facility and in my travels of all ages and in wide ranges of heath; the amputees without ERTL are sensitive to end pressure and squeezing pressure of the tibia and fibula. Long term amputee’s grow more pointed and tapered and have more difficulties with socket fit.

My company can gather a fair number of amputees with the ERTL at one time,. Some have had standard amputations before and were revised to an ERTL, while others, such as myself, were done at initial surgery. We all feel we are extremely lucky to have had this procedure. I don’t know any ERTL amputee that doesn’t like it and would prefer to be revised with to a standard amputation style. Amputee’s with the ERTL tend to have rounder fuller, longer distal ends, are able to bear more pressure distally, have no problems with medial/lateral squeeze and if the socket is fit correctly will have no problems there either.

I think it’s important to work at improving the life of amputees and a simple way is the ERTL. I know that this is not for everyone and a blank statement that the ERTL is great for all is massively incorrect. At the same time, the same pertains to the standard amputation.  Give us a better chance at a better life. We are very lucky to have the influence and guidance of many incredible Doctors, such as Doctors  Jan Ertl, Marco Guedes, Dan Unger, Attila Poka, Joel Stewart, Claude  Anderson and Scott Helmers, just to name a few.

Thanks,

Larry Corley