On June 25, 2001, my life drastically changed. While helping a close friend with the construction of an auto repair shop, I fell from a height of approximately 12 feet. Due to the angle of the fall, I suffered a shattered right ankle as well as a compound fracture of both the right tibia and fibula. Additionally, prior to the completion of the fall, the exposed upper portions of the tibia and fibula were embedded into the ground approximately two and a half inches.

The next two years, I underwent ten surgical procedures, some of which included:

After several hospital stays, consulting numerous physicians of multiple specialties, and over two years of almost constant (and increasing) pain, I approached my latest specialist with the idea of amputation. During this conversation, I was told that a new surgeon had arrived in Oklahoma City within the previous year, and this surgeon's amputation procedure would be the best for me. I was advised that the procedure was highly effective for getting patients back to their original level of activity. An appointment was made, and I meet with the new surgeon.

My initial meeting with my 'amputation specialist' (Dr. Will Ertl) went very well. He described the Osteomyoplastic Lower Extremity Amputation Reconstruction Technique (more commonly referred to the Ertl Procedure) that he preferred to use during amputation surgeries. As he was describing the procedure, every step seemed logical in it's purpose. After that appointment, I started my own research via the internet.

I stumbled across the <http://www.oandp.com> website and found a review of report by a military doctor and his five year experience with over 150 transtibial Ertl revisions. While I wasn't to undergo a revision, this report defiantly assisted my decision to proceed with the Ertl Procedure as opposed to the 'conventional' method. The paper from the military doctor ended with:

 We conclude that the Ertl osteoplasty produces the optimum stump for the young adult amputee providing him with the most favorable prognosis for successful and lasting total contact prosthetic fitting with its attendant benefit and opportunity for return to maximum lower extremity Function.

This report review can be found at: <http://www.oandp.com/news/jmcorner/2003-09/1.asp>

As a result of my research, my personal opinion concerning the Ertl Procedure compared to the 'conventional' method was that the conventional method would have been acceptable during the previous centuries. However, after the concept of the Ertl Procedure was perfected, I don't see why anyone would want the conventional method performed on them. Just as the medical community continues to improve other procedures, I can't understand why a procedure as important as an amputation hasn't naturally progressed as well.

After much prayer and continued counseling with both Dr. Ertl and other below knee amputees, I scheduled my surgery for Dec 4, 2003 (two and a half years after the accident which started me down this path). My surgeon advised my hospital stay would be 3-5 days, which I thought to be extremely optimistic, considering the severity of the surgery.

On Thursday, Dec 4, a last minute review of the procedure was provided by Dr. Ertl as I was in the pre-op area, which included the reminder that a nerve block would be applied to my leg just after the surgery. As I regained consciousness in the recovery room, I surprisingly had no pain whatsoever, then remember the nerve block. As the block wore off, my pain was managed via an IV, but I was already aware that discharge wouldn't occur until I was able to control my pain via pills. Saturday morning, less than 48 hours after leaving the operating room, my surgical dressing was removed and a six inch elastic dressing was lightly wrapped around my new residual limb. My surgeon came in a few minutes later and removed the dressing, stating that he wanted it left unwrapped, with no tension on the limb. This initially surprised me as my research had indicated that pressure wraps should be applied post-operatively, to assist with the swelling. Prior to the surgery, I had been nervous that I wouldn't apply the correct amount of pressure when I re-applied the dressing (either to loose or too tight), but this fear was dispelled by my surgeon.

Prior to my surgery, I wore a narcotic patch 24x7, in an attempt to reduce the amount of pain experienced on a daily basis (complete removal of the pain wasn't seen as a possible option). The amount of pain I was in by Saturday evening was unbelievable. Unbelievable, in the fact that there was almost no pain! I hadn't been pain-free in so many months, I had forgotten what it was like. The IV pain control was removed and I was moved to controlling the low amount of pain by oral medications. While I was thought 3-5 days was overly optimistic, I was released from the hospital on Monday, Dec 8, just less than 96 hours (four days) after leaving the post-op recovery area.

Upon arriving home, everyone who visited me was amazed at the condition of my residual limb, and commented on the change in my outward appearance, which was directly related to the removal of the always painful limb. Two of the visitors had previously been nurses (one had actually been an OR nurse and had been present on numerous 'conventional' below knee amputations) and both commented on the obvious quality of work on my residual limb. Upon explaining the Ertl procedure to both of the nurses, they were impressed with the amount of detail that was addressed by the surgeon, and both noted that the steps taken should ensure my ability to return to my previous level of activity.

Other than having to use assistive devices for transportation (crutches, walker or wheelchair), physically I am feeling better than I have since the accident. Going into the surgery, I was under the misconception that it would be several weeks (possibly a month) prior to 'feeling like myself again'. Quite surprisingly, I feeling like myself again prior to leaving the hospital.

The common question posed to me currently concerns "phantom pain". Considering the amount of pain I was in previously, I wasn't overly concerned with the idea of phantom pain prior to my surgery. I prefer to call what I experience as "phantom annoyance", as it feels more like an extremely tight shoe is sometimes placed on my missing foot. At times, a sharp pain will occur, but it usually subsides within a few seconds. I am no longer on any prescription medication, simply taking other the counter pain medication occasionally, as needed.

It is still early in my recovery; however, I personally believe that I will return to almost 100% of my previous activity level within a year. While this will depend upon my internal drive and determination, as well as the quality of prosthetic equipment I acquire, I do not believe this would be possible without the foundation of a solid residual limb to build upon. Just as when building a house, having a reliable builder and quality materials ultimately depends upon a firm foundation to build upon.

Update ... July 2004:

I am now just over seven months post-op, and have had my prosthetic leg for five months (got the leg 8 weeks post-op). My initial fitting went very smoothly and I was actually walking unassisted (no crutches, cane or hand-rails) within approximately 30 minutes of donning the leg. I am currently using an Alpha liner with locking-pin suspension method socket, with an Ohio Willow Wood Pathfinder (Low Profile) foot/ankle unit. While it is extremely hard to believe, that was really the first time I had walked without pain since June 2001!

I have since had a socket replacement, since I have lost so much volume in my residual limb. With the new socket, as long as I have the right number of liner socks on (since my socket is a total-contact type), I can do pretty much any level of activity I was able to do prior to my initial accident. I tire a little quicker than before, but that is due to the fact I'm not back in the overall shape I was three years ago. Since I have adjusted to my new leg (or 'fake leg' as my four year old calls it), I have been able to do the following:

Update ... Oct 2004:

Through a variety of venues (my surgeon, CP or amputee email lists), I have been put in contact with several people who are either about to become amputees, or have recently become an amputee.  Through these contacts I am able to share my past experiences (see above) as well as be a contact point for various amputee-related questions.  When people wonder why this has happened to me, I usually answer that part of the reason is so that I can help others through their situations.  Just yesterday my wife and I were able to sit with a gentleman while his wife was going through the same surgery I had in Dec 2003.  We were able to answer questions and provide insight as to what they could expect over the next few months.

Update ... Nov 2004:

I have been given the privilege of being the webmaster for the ErtlReconstruction.com website

Update ... Jan 2005:

At only 13 months post-op, my CP asked me to attend a training session on a new prosthetic suspension system (to be his test patient).  The trip was a blast as I got to spend some quality time (as opposed to clinical time) with a wonderful guy.  The training session was great as well, especially when I demonstrated (otherwise known as "showing off") the ability to go 100% weight bearing on the distal end of my residual limb.  One of the CPs in the room stated "You can't do that!", to which I replied, "What, this?" as I extended my 'good  leg' out in front of me while standing on the end of my residual limb.  The next ten minutes were spent explaining the Ertl Procedure, as well as the speed in which I was able to get back to an active lifestyle. 

Update ... July 2006:

I just completed 5 days with the Amputees Across America riders.  It was a wonderful time spent by two days of bike riding (from Oklahoma City to Dallas) followed by three days of visitations to area HealthSouth Rehab hospitals as well as the Texas Scottish Rites Children's hospitals.  The visitation allowed us to share with patients and staff alike the fact that "limb loss doesn't equal life loss".  I was also able to share the benefits of the Ertl Procedure with the medical staff of the facilites, as well as leave behind key information about the procedure.

August 2007:

Started working/lecturing on a regular basis at the University of Oklahoma Health Sciences Center (OUHSC) in Oklahoma City. I have spoken to classes ranging from physical therapy and prosthetic students and even surgical residency students. The lecture topics have covered quality of life for amputees, gate training (evaluate walking ability for adjusting prosthesis components) and amputee support issues.

April 2008:

Spoke at a national medical symposium covering the the surgical procedure method used for the amputation of my leg, as well as sat on the panel of the closing Q&A session for the symposium.

More updates to follow

Please visit my webpage at http://ErtlGuy.net and blogs at http://tisgarplen.blogspot.com and http://ronking.blogspot.com or email me at ron.king@gmail.com