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Summary

for people ages 18–60 (full criteria)
at San Francisco, California and other locations
study started
estimated completion:

Description

Summary

The goals of the TAOS study is to determine the best procedures for below the knee amputations. There are two different procedures currently used by surgeons around the county: the Erlt procedure and the Burgess procedure. Proponents of the Ertl procedure advocate that the surgical formation of a tibia to fibula bone bridge provides stability, shape and weight bearing capability to the residual limb that result in less pain and better prosthetic fit and alignment. This procedure is popular especially among the military but it's advantages over the Burgess procedure are not well supported by current research. This study aims to compare the two amputation procedures in an adequately powered randomized trial.

Official Title

Transtibial Amputation Outcomes Study (TAOS): Comparing Transtibial Amputation With (Ertl) and Without a Tibia-fibula Synostosis Procedure

Details

High-energy open fractures, blast, gunshot wound and crush injuries to the distal tibia, ankle, hind foot and midfoot are common challenges to military and civilian trauma surgeons (Brown, 2009; Covey, 2002; Ficke, 2007; McGuigan, 2007; Hansen, 2001). Many surgeons believe that an early transtibial amputation provides a better long term functional outcome than limb salvage for these injuries (Hansen, 2001; Myerson, 1994; Sanders, 1992; Turchin,1999; Shawen, 2010;Ellington 2012). If a transtibial amputation is selected as the treatment for the patient, a controversy remains regarding the appropriate amputation technique. Many surgeons advocate for an amputation with a tibia-fibula synostosis technique (Ertl procedure) in young and active patients, believing that this procedure provides a better prosthetic interface, an end bearing capacity and soft tissue stability that improves performance and functional outcomes. (Pinto 2004; Pinzur 2006; Commuri 2010). Others strongly advocate for a standard posterior flap (Burgess procedure) without the synostosis, arguing that patients have similar outcomes with fewer complications and lower costs. (Pinzur 2008; Tindle 2011) To date, the outcomes of the transtibial amputation techniques have not been subjected to an appropriately powered prospective randomized clinical trial.

The primary study objective is to compare functional outcomes and number of revision surgeries to the amputated limb after first amputation for patients undergoing a transtibial amputation and randomized to receive a tibia-fibula synostosis (Ertl procedure) versus a standard posterior flap procedure (Burgess procedure).

The secondary study objectives are to compare levels of impairment for patients undergoing a transtibial amputation and randomized to receive a tibia-fibula synostosis (Ertl procedure) versus a standard posterior flap procedure (Burgess procedure); to compare levels of pain for patients undergoing a transtibial amputation and randomized to receive a tibia-fibula synostosis (Ertl procedure) versus a standard posterior flap procedure (Burgess procedure); and to compare initial hospitalization and overall treatment costs (through the 18 month follow-up) for patients undergoing a transtibial amputation and are randomized to receive a tibia-fibula synostosis (Ertl procedure) versus a standard posterior flap procedure (Burgess procedure). Patients who refuse randomization have the option of participating in a prospective observational study and the type of amputation is decided by the surgeon and patient.

Keywords

Transtibial Amputation

Eligibility

You can join if…

Open to people ages 18–60

  • Patients requiring a unilateral transtibial amputation following major limb trauma regardless of when the injury occurred
  • The injury and its treatment must meet the following criteria:
  • The residual fibula is not fractured or if fractured, is stabilized by internal fixation allowing for either the Ertl or Burgess procedure
  • Proximal tibia/fibula joint is stabilized
  • Soft tissue coverage allows for atypical closure and skin graft <100 cm2
  • Amputation will result in a residual limb that is ≥10 cm from joint line to end of tibia
  • Ages 18 and 60 inclusive

You CAN'T join if...

  • At time of consent, patient has a Glasgow Coma Scale (GCS) motor score of 0-4 or a GCS motor score of 5 with a significant traumatic brain injury (defined as an AIS code of 5 or 6)
  • Patients with wound closure requiring a free tissue transfer
  • Fibula fractures proximal to the tibial bone cut that cannot be stabilized
  • Late amputation with presence of one of the following conditions: (i) infection within the zone of injury; (ii) chronic regional pain syndrome; (iii) post-traumatic thrombophlebitis
  • Patient has a spinal cord deficit
  • Patient has a previous leg or foot amputation or is non-ambulatory pre-injury
  • Patient has third degree burns on >10% total surface area affecting the study limb
  • Patient has a documented psychiatric disorder
  • Patient is unable to speak either English or Spanish
  • Severe problems with maintaining follow-up (e.g. patients who are prisoners or homeless at the time of injury or who are intellectually challenged without adequate family support).
  • Patient has an amputation to one or both upper extremities (excluding digits)
  • Patient is outside hospital's catchment area
  • Patient follow-up is planned at another medical center

Locations

  • Naval Medical Center San Diego withdrawn
    San Diego, California, 92134, United States
  • University of Washington/ Harborview Medical Center accepting new patients
    Seattle, Washington, 98104, United States
  • University of Oklahoma accepting new patients
    Oklahoma City, Oklahoma, 73104, United States
  • San Antonio Miliary Medical Center accepting new patients
    Fort Sam Houston, Texas, 78234-6315, United States
  • UT Health: The University of Texas Health Science Center at Houston Medical School accepting new patients
    Houston, Texas, 77030, United States
  • Hennepin County Medical Center accepting new patients
    Minneapolis, Minnesota, 55430, United States
  • University of Iowa Hospitals & Clinics withdrawn
    Iowa City, Iowa, 52242, United States
  • Barnes Jewish Hospital accepting new patients
    Saint Louis, Missouri, 63110, United States
  • St. Louis University Medical Center accepting new patients
    Saint Louis, Missouri, 63110, United States
  • University of Mississippi Medical Center accepting new patients
    Jackson, Mississippi, 39216, United States
  • Vanderbilt University Medical Center accepting new patients
    Nashville, Tennessee, 37232, United States
  • Eskenazi Health accepting new patients
    Indianapolis, Indiana, 46202, United States
  • Methodist Hospital accepting new patients
    Indianapolis, Indiana, 46202, United States
  • Orthopaedic Associates of Michigan, Spectrum Health withdrawn
    Grand Rapids, Michigan, 49503, United States
  • Grant Medical Center withdrawn
    Columbus, Ohio, 43215, United States
  • Emory University School of Medicine accepting new patients
    Atlanta, Georgia, 30303, United States
  • MetroHealth Medical Center accepting new patients
    Cleveland, Ohio, 44109, United States
  • University of Pittsburgh Medical Center accepting new patients
    Pittsburgh, Pennsylvania, 15219, United States
  • Carolinas Medical Center accepting new patients
    Charlotte, North Carolina, 28232, United States
  • Wake Forest University Baptist Medical Center accepting new patients
    Winston-Salem, North Carolina, 27157, United States
  • Florida Orthopaedic Institute- Tampa General Hospital accepting new patients
    Tampa, Florida, 33606, United States
  • Walter Reed National Military Medical Center accepting new patients
    Bethesda, Maryland, 20889, United States
  • Penn State University M.S. Hershey Medical Center accepting new patients
    Hershey, Pennsylvania, 17033, United States
  • University of Maryland/R Adams Cowley Shock Trauma Medical Center accepting new patients
    Baltimore, Maryland, 212101, United States
  • Naval Medical Center Portsmouth accepting new patients
    Portsmouth, Virginia, 23708, United States
  • University of Miami Ryder Trauma Center accepting new patients
    Miami, Florida, 33136, United States
  • Rhode Island Hospital, Brown University accepting new patients
    Providence, Rhode Island, 02903, United States

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Major Extremity Trauma Research Consortium
ID
NCT01821976
Lead Scientist
Theodore Miclau
Study Type
Interventional
Last Updated
April 1, 2017
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