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A Comparison of Limb-Socket Kinematics of Bone-Bridging and Non-Bone-Bridging Wartime Transtibial Amputations
MAJ Christopher J. Tucker, MD1; Jason M. Wilken, MPT, PhD2; Daniel J. Stinner, MD1; LTC Kevin L. Kirk, DO1
1 Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, 3851 Rogers Brooke Drive, Fort Sam Houston, TX 78234. E-mail address for D.J. Stinner: daniel.stinner@amedd.army.mil
2 Military Performance Lab, Center for the Intrepid, 3425 Beach Drive, Fort Sam Houston, TX 78234
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Investigation performed at the Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, Texas

Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government. All authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 16;94(10):924-930. doi: 10.2106/JBJS.K.00605
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While there are proponents of both bone-bridging and non-bone-bridging transtibial amputation techniques, there is a lack of evidence describing functional differences between these two techniques. The goal of the present investigation was to objectively compare the techniques of bone-bridging and non-bone-bridging with respect to limb socket displacement during physiologic loading.


Fifteen male subjects with an average age of twenty-seven years (range, twenty-two to thirty-two years) who had undergone a unilateral transtibial amputation secondary to a traumatic wartime injury were prospectively evaluated. Seven patients had undergone a bone-bridging amputation, and eight had undergone a non-bone-bridging amputation. Digital fluoroscopic video was used to measure the vertical displacement of the limb within a total-surface-bearing socket with weight-bearing from 0% to 100% of body weight.


There was no difference in limb-socket displacement between amputation techniques with initial loading (12.78 mm for the bone-bridging group, compared with 12.43 mm for the non-bone-bridging group; p = 0.88) or with total loading (p = 0.98). Similarly, there was no difference between suspension mechanisms in limb-socket displacement with initial loading (12.15 mm for patients with pin lock suspension, compared with 12.98 mm for those with suction sleeve suspension; p = 0.72) or with total loading (18.24 mm for patients with pin lock suspension, compared with 21.42 mm for those with suction sleeve suspension, p = 0.21).


The current study demonstrated no difference between surgical techniques with respect to bone-socket displacement. These data provide no evidence to support statements that bone-bridging contributes to a more efficient platform in the total-surface-bearing socket.

Level of Evidence: 

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

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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