Modified Ertl technique. A, Skin incision marked to create long posterior flap. B, Elevation of osteoperiosteal flap from the tibia. C, Provisional notch created in distal tibia and fibula for fibular strut. D, Fibular strut placed into the tibial and fibular notches. E, Fibular strut secured via sutures through bone tunnels. (A, B, and E, From: Taylor BC, Poka A: Osteomyoplastic transtibial amputation: the Ertl technique, J Am Acad Orthop Surg 24:259, 2016. C and D, From Taylor BC, Poka A: Osteomyoplastic transtibial amputation: technique and tips, J Orthop Surg Res 6:13, 2011.) SEE TECHNIQUE 16.2.