Combined Distraction Osteogenesis and Papineau Technique for an Open Fracture Management of the Distal Lower Extremity

A plethora of surgical protocols have been described to treat open severe lower extremity fractures. These include and are not limited to early aggressive and repeated d ebridement of necrotic tissue, fracture stabilization with external fixation, early soft tissue coverage with local muscle flaps or free muscle transfers, and staged skeletal reconstruction. For bone defect reconstruction, different techniques have been described, including direct nonvascularized cancellous bone grafts, open cancellous Papineau grafting, bone transport using the Ilizarov bone-lengthening technique, and vascularized bone grafts. Initial d ebridement with incomplete bone resection followed by repeated local soft tissue management was originally described by Papineau in 1973. In this technique, serial local d ebridements are performed and followed by the excision of the infected bone and soft tissue defects whereas the posterior bone cortex is