| Step | Standard Amputation | Ertl Amputation | |------|---------------------|------------------| | | Tibia beveled, fibula cut shorter | Tibia & fibula cut transversely | | Synostosis | None | Cortico-cancellous bone graft placed between tibia/fibula | | Distal end | Soft tissue only | Bone bridge + vascularized periosteal flap | | Muscle | Myodesis (muscle to bone) | Myoplasty + myodesis over bone bridge |
| Step | Standard Amputation | Ertl Amputation | |------|---------------------|------------------| | | Tibia beveled, fibula cut shorter | Tibia & fibula cut transversely | | Synostosis | None | Cortico-cancellous bone graft placed between tibia/fibula | | Distal end | Soft tissue only | Bone bridge + vascularized periosteal flap | | Muscle | Myodesis (muscle to bone) | Myoplasty + myodesis over bone bridge |
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