Management of open fractures and subsequent complications

Journal of Bone and Joint Surgery

Volumn 89, Issue 4, 2007, Pages 884-895

  Zalavras, Charalampos G ^a   Marcus, Randall E ^b   Levin, L Scott ^c   Patzakis, Michael J ^a  

^a UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

^b CASE WESTERN RESERVE UNIVERSITY   (United States)

^c DUKE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMINOGLYCOSIDE ANTIBIOTIC AGENT; AMPICILLIN; ANTIBIOTIC AGENT; AZTREONAM; BONE MORPHOGENETIC PROTEIN; BONE MORPHOGENETIC PROTEIN 12; BONE MORPHOGENETIC PROTEIN 15; BONE MORPHOGENETIC PROTEIN 2; BONE MORPHOGENETIC PROTEIN 4; BONE MORPHOGENETIC PROTEIN 5; BONE MORPHOGENETIC PROTEIN 6; BONE MORPHOGENETIC PROTEIN 9; CEFAZOLIN; CEPHALOSPORIN; CEPHALOSPORIN DERIVATIVE; DALFOPRISTIN PLUS QUINUPRISTIN; GENTAMICIN; LINEZOLID; OSTEOGENIC PROTEIN 1; OSTEOGENIN; OXACILLIN; PENICILLIN DERIVATIVE; PROCOLLAGEN C PROTEINASE; QUINOLINE DERIVED ANTIINFECTIVE AGENT; RECOMBINANT BONE MORPHOGENETIC PROTEIN 2; RECOMBINANT OSTEOGENIC PROTEIN 1; TOBRAMYCIN; TRANSFORMING GROWTH FACTOR BETA; UNINDEXED DRUG; VANCOMYCIN;

ANTIBIOTIC THERAPY; DEBRIDEMENT; DRUG DOSE COMPARISON; FRACTURE FIXATION; FRACTURE HEALING; HUMAN; OPEN FRACTURE; POSTOPERATIVE COMPLICATION; POSTOPERATIVE INFECTION; PRIORITY JOURNAL; REVIEW; WOUND HEALING;

EID: 34147113331     PISSN: 00219355     EISSN: None     Source Type: Journal    
DOI: 10.2106/00004623-200704000-00027     Document Type: Review

References (109)

1. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68:1348-53.
2. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453-8.
3. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742-6.
4. Brumback RJ, Jones AL. Interobserver agreement in the classification of open fractures of the tibia. The results of a survey of two hundred and forty-five orthopaedic surgeons. J Bone Joint Surg Am. 1994;76:1162-6.
5. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36-40.
6. Bowen TR, Widmaier JC. Host classification predicts infection after open fracture. Clin Orthop Relat Res. 2005;433:205-11.
7. Patzakis MJ, Harvey JP Jr, Ivler D. The role of antibiotics in the management of open fractures. J Bone Joint Surg Am. 1974;56:532-41.
8. Skaggs DL, Friend L, Alman B, Chambers HG, Schmitz M, Leake B, Kay RM, Flynn JM. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005;87:8-12.
9. Patzakis MJ, Wilkins J, Moore TM. Considerations in reducing the infection rate in open tibial fractures. Clin Orthop Relat Res. 1983;178:36-41.
10. Patzakis MJ, Bains RS, Lee J, Shepherd L, Singer G, Ressler R, Harvey F, Holtom P. Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, ciprofloxacin, to combination antibiotic therapy in open fracture wounds. J Orthop Trauma. 2000;14:529-33.
11. Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res. 1997;339:71-5.
12. Fischer MD, Gustilo RB, Varecka TF. The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury. J Bone Joint Surg Am. 1991;73:1316-22.
13. Templeman DC, Gulli B, Tsukayama DT, Gustilo RB. Update on the management of open fractures of the tibial shaft. Clin Orthop Relat Res. 1998;350:18-25.
14. Patzakis MJ. Clostridial myonecrosis. Instr Course Lect. 1990;39:491-3.
15. Zalavras CG, Patzakis MJ. Open fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11:212-9.
16. Ostermann PA, Seligson D, Henry SL. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br. 1995;77:93-7.
17. Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. 2004;427:86-93.
18. Levin LS. The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am. 1993;24:393-409.
19. Levin LS, Nunley JA. The management of soft-tissue problems associated with calcaneal fractures. Clin Orthop Relat Res. 1993;290:151-6.
20. Heitmann C, Khan FN, Levin LS. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg. 2003;19:157-62.
21. Baumeister S, Levin LS, Erdmann D. [Literature and own strategies concerning soft-tissue reconstruction and exposed osteosynthetic hardware]. Chirurg. 2006;77:616-21. German.
22. Oishi SN, Levin LS, Pederson WC. Microsurgical management of extremity wounds in diabetics with peripheral vascular disease. Plast Reconstr Surg. 1993;92:485-92.
23. Levin LS. Soft tissue coverage options for ankle wounds. Foot Ankle Clin. 2001;6:853-66, ix.
24. Erdmann D, Lee B, Roberts CD, Levin LS. Management of lawnmower injuries to the lower extremity in children and adolescents. Ann Plast Surg. 2000;45:595-600.
25. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78:285-92.
26. Heitmann C, Levin LS. The orthoplastic approach for management of the severely traumatized foot and ankle. J Trauma. 2003;54:379-90.
27. Levin LS. New developments in flap techniques. J Am Acad Orthop Surg. 2006;14(10 Suppl):S90-3.
28. Erdmann D, Sweis R, Wong MS, Niklason LE, du Laney TV, Levin LS, Klitzman B, Olbrich KC. Vascular endothelial growth factor expression in pig latissimus dorsi myocutaneous flaps after ischemia reperfusion injury. Plast Reconstr Surg. 2003;111:775-80.
29. Heller L, Levin LS. Lower extremity microsurgical reconstruction. Plast Reconstr Surg. 2001;108:1029-41; quiz 1042.
30. Heitmann C, Patzakis MJ, Tetsworth KD, Levin LS. Musculoskeletal sepsis: principles of treatment. Instr Course Lect. 2003;52:733-43.
31. Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br. 2000;82:959-66.
32. Worlock P, Slack R, Harvey L, Mawhinney R. The prevention of infection in open fractures: an experimental study of the effect of fracture stability. Injury. 1994;25:31-8.
33. Brumback RJ, Ellison PS Jr, Poka A, Lakatos R, Bathon GH, Burgess AR. Intramedullary nailing of open fractures of the femoral shaft. J Bone Joint Surg Am. 1989;71:1324-31.
34. Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12:1-7.
35. Tornetta P 3rd, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76:13-9.
36. Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect. 2005;54:447-62.
37. Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62-8.
38. Shepherd LE, Costigan WM, Gardocki RJ, Ghiassi AD, Patzakis MJ, Stevanovic MV. Local or free muscle flaps and unreamed interlocked nails for open tibial fractures. Clin Orthop Relat Res. 1998;350:90-6.
39. Schemitsch EH, Kowalski MJ, Swiontkowski MF, Senft D. Cortical bone blood flow in reamed and unreamed locked intramedullary nailing: a fractured tibia model in sheep. J Orthop Trauma. 1994;8:373-82.
40. Schemitsch EH, Kowalski MJ, Swiontkowski MF, Harrington RM. Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia. J Orthop Res. 1995;13:382-9.
41. Keating JF, Blachut PA, O'Brien PJ, Meek RN, Broekhuyse H. Reamed nailing of open tibial fractures: does the antibiotic bead pouch reduce the deep infection rate? J Orthop Trauma. 1996;10:298-303.
42. Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14:187-93.
43. Edwards CC, Simmons SC, Browner BD, Weigel MC. Severe open tibial fractures. Results treating 202 injuries with external fixation. Clin Orthop Relat Res. 1988;230:98-115.
44. Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br. 1986;68:246-54.
45. Marsh JL, Nepola JV, Wuest TK, Osteen D, Cox K, Oppenheim W. Unilateral external fixation until healing with the dynamic axial fixator for severe open tibial fractures. J Orthop Trauma. 1991;5:341-8.
46. Blick SS, Brumback RJ, Lakatos R, Poka A, Burgess AR. Early prophylactic bone grafting of high-energy tibial fractures. Clin Orthop Relat Res. 1989;240:21-41.
47. McGraw JM, Lim EV. Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. J Bone Joint Surg Am. 1988;70:900-11.
48. Blachut PA, Meek RN, O'Brien PJ. External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol. J Bone Joint Surg Am. 1990;72:729-35.
49. Harwood PJ, Giannoudis PV, van Griensven M, Krettek C, Pape HC. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma. 2005;58:446-54.
50. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82:781-8.
51. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48:613-23.
52. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71:159-69.
53. Moed BR, Kellam JF, Foster RJ, Tile M, Hansen ST Jr. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg Am. 1986;68:1008-17.
54. Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am. 1986;68:430-3.
55. Mostafavi HR, Tornetta P 3rd. Open fractures of the humerus treated with external fixation. Clin Orthop Relat Res. 1997;337:187-97.
56. Marsh JL, Mahoney CR, Steinbronn D. External fixation of open humerus fractures. Iowa Orthop J. 1999;19:35-42.
57. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999;13:78-84.
58. Watson JT. High-energy fractures of the tibial plateau. Orthop Clin North Am. 1994;25:723-52.
59. Tornetta P 3rd, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, Yang E. Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma. 1993;7:489-96.
60. Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB. Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma. 1992;6:78-86.
61. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA. Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma. 2004;18:509-20.
62. Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma. 2004;18:552-8.
63. Seligson D, Ostermann PA, Henry SL, Wolley T. The management of open fractures associated with arterial injury requiring vascular repair. J Trauma. 1994;37:938-40.
64. Ashworth EM, Dalsing MC, Glover JL, Reilly MK. Lower extremity vascular trauma: a comprehensive, aggressive approach. J Trauma. 1988;28:329-36.
65. Reber PU, Patel AG, Sapio NL, Ris HB, Beck M, Kniemeyer HW. Selective use of temporary intravascular shunts in coincident vascular and orthopedic upper and lower limb trauma. J Trauma. 1999;47:72-6.
66. Stringa G. Studies of the vascularisation of bone grafts. J Bone Joint Surg Br. 1957;39:395-420.
67. Urist MR, McLean FC. Osteogenetic potency and new-bone formation by induction in transplants to the anterior chamber of the eye. J Bone Joint Surg Am. 1952;34:443-76.
68. Dell PC, Burchardt H, Glowczewskie FP Jr. A roentgenographic, biomechanical, and histological evaluation of vascularized and non-vascularized segmental fibular canine autografts. J Bone Joint Surg Am. 1985;67:105-12.
69. Sharrard WJ. A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures. J Bone Joint Surg Br. 1990;72:347-55.
70. Scott G, King JB. A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones. J Bone Joint Surg Am. 1994;76:820-6.
71. Brighton CT, Shaman P Heppenstall RB, Esterhai JL Jr, Pollack SR, Friedenberg ZB. Tibial nonunion treated with direct current, capacitive coupling, or bone graft. Clin Orthop Relat Res. 1995;321:223-34.
72. Corradi C, Cozzolino A. [The action of ultrasound on the evolution of an experimental fracture in rabbits]. Minerva Ortop. 1952;55:44-5. Italian.
73. Cook SD, Ryaby JP, McCabe J, Frey JJ, Heckman JD, Kristiansen TK. Acceleration of tibia and distal radius fracture healing in patients who smoke. Clin Orthop Relat Res. 1997;337:198-207.
74. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am. 1994;76:26-34.
75. Rubin C, Bolander M, Ryaby JP, Hadjiargyrou M. The use of low-intensity ultrasound to accelerate the healing of fractures. J Bone Joint Surg Am. 2001;83:259-70.
76. Duarte LR, Xavier CA, Choffie M, McCabe JM. Review of nonunions treated by pulsed low-intensity ultrasound. In: Proceedings of the 1996 Meeting of the Société Internationale de Chirurgie Orthopaedique et de Traumatologie (SICOT); 1996 Aug 18-23; Amsterdam, p 110.
77. Urist MR. Bone: formation by autoinduction. Science. 1965;150:893-9.
78. Wozney JM, Rosen V, Celeste AJ, Mitsock LM, Whitters MJ, Kriz RW, Hewick RM, Wang EA. Novel regulators of bone formation: molecular clones and activities. Science. 1988;242:1528-34.
79. Celeste AJ, Iannazzi JA, Taylor RC, Hewick RM, Rosen V, Wang EA, Wozney JM. Identification of transforming growth factor beta family members present in bone-inductive protein purified from bovine bone. Proc Natl Acad Sci USA. 1990;87:9843-7.
80. Ozkaynak E, Schnegelsberg PN, Jin DF, Clifford GM, Warren FD, Drier EA, Oppermann H. Osteogenic protein-2. A new member of the transforming growth factor-beta superfamily expressed early in embryogenesis. J Biol Chem. 1992;267:25220-7.
81. Barnes GL, Kostenuik PJ, Gerstenfeld LC, Einhorn TA. Growth factor regulation of fracture repair. J Bone Miner Res. 1999;14:1805-15.
82. Gerstenfeld LC, Cullinane DM, Barnes GL, Graves DT, Einhorn TA. Fracture healing as a postnatal developmental process: molecular, spatial, and temporal aspects of its regulation. J Cell Biochem. 2003;88:873-84.
83. Glienke J, Schmitt AO, Pilarsky C, Hinzmann B, Weiss B, Rosenthal A, Thierauch KH. Differential gene expression by endothelial cells in distinct angiogenic states. Eur J Biochem. 2000;267:2820-30.
84. Wozney JM, Rosen V. Bone morphogenetic protein and bone morphogenetic protein gene family in bone formation and repair. Clin Orthop Relat Res. 1998;346:26-37.
85. Cheng H, Jiang W, Phillips FM, Haydon RC, Peng Y, Zhou L, Luu HH, An N, Breyer B, Vanichakarn P, Szatkowski JP, Park JY, He TC. Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs). J Bone Joint Surg Am. 2003;85:1544-52. Erratum in: J Bone Joint Surg Am. 2004;86:141.
86. Govender S, Csimma C, Genant HK, Valentin-Opran A, Amit Y, Arbel R, Aro H, Atar D, Bishay M, Borner MG, Chiron P, Choong P, Cinats J, Courtenay B, Feibel R, Geulette B, Gravel C, Haas N, Raschke M, Hammacher E, van der Velde D, Hardy P, Holt M, Josten C, Ketterl RL, Lindeque B, Lob G, Mathevon H, McCoy G, Marsh D, Miller R, Munting E, Oevre S, Nordsletten L, Patel A, Pohl A, Rennie W, Reynders P, Rommens PM, Rondia J, Rossouw WC, Daneel PJ, Ruff S, Ruter A, Santavirta S, Schildhauer TA, Gekle C, Schnettler R, Segal D, Seiler H, Snowdowne RB, Stapert J, Taglang G, Verdonk R, Vogels L, Weckbach A, Wentzensen A, Wisniewski T; BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) Study Group. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am. 2002;84:2123-34.
87. McKee MD. The effect of human recombinant bone morphogenic protein (rh-BMP-7) on the healing of open tibial shaft fractures: results of a multicentre, prospective, randomized clinical trial. Read at the Annual Meeting of the American Academy of Orthopaedic Surgeons; 2003 Feb 5-9; New Orleans, LA.
88. Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S. Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am. 2001;83 Suppl 1(Pt 2):S151-8.
89. Termaat MF, Den Boer FC, Bakker FC, Patka P, Haarman HJ. Bone morphogenetic proteins. Development and clinical efficacy in the treatment of fractures and bone defects. J Bone Joint Surg Am. 2005;87:1367-78.
90. Betz OB, Betz VM, Nazarian A, Pilapil CG, Vrahas MS, Bouxsein ML, Gerstenfeld LC, Einhorn TA, Evans CH. Direct percutaneous gene delivery to enhance healing of segmental bone defects. J Bone Joint Surg Am. 2006;88:355-65.
91. Baltzer AW, Lattermann C, Whalen JD, Wooley P, Weiss K, Grimm M, Ghivizzani SC, Robbins PD, Evans CH. Genetic enhancement of fracture repair: healing of an experimental segmental defect by adenoviral transfer of the BMP-2 gene. Gene Ther. 2000;7:734-9.
92. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005;13:417-27.
93. Tetsworth K, Cierny G 3rd. Osteomyelitis debridement techniques. Clin Orthop Relat Res. 1999;360:87-96.
94. Patzakis MJ, Wilkins J, Kumar J, Holtom P, Greenbaum B, Ressler R. Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones. A prospective study. J Bone Joint Surg Am. 1994;76:664-6.
95. McKee MD, Wild LM, Schemitsch EH, Waddell JP. The use of an antibiotic-impregnated, osteoconductive, bioabsorbable bone substitute in the treatment of infected long bone defects: early results of a prospective trial. J Orthop Trauma. 2002;16:622-7.
96. Patzakis MJ. Management of acute and chronic osteomyelitis. In: Chapman MW, Szabo RM, Marder RA, Vince KG, Mann RA, Lane JM, McLain RF, Rab G, editors. Chapman's orthopaedic surgery. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p 3533-59.
97. Rao N, Ziran BH, Hall RA, Santa ER. Successful treatment of chronic bone and joint infections with oral linezolid. Clin Orthop Relat Res. 2004;427:67-71.
98. Patzakis MJ, Abdollahi K, Sherman R, Holtom PD, Wilkins J. Treatment of chronic osteomyelitis with muscle flaps. Orthop Clin North Am. 1993;24:505-9.
99. Gayle LB, Lineaweaver WC, Oliva A, Siko PP, Alpert BS, Buncke GM, Yim K, Buncke HJ. Treatment of chronic osteomyelitis of the lower extremities with debridement and microvascular muscle transfer. Clin Plast Surg. 1992;19:895-903.
100. Swiontkowski MF, Hanel DP, Vedder NB, Schwappach JR. A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis. J Bone Joint Surg Br. 1999;81:1046-50.
101. Reckling FW, Waters CH 3rd. Treatment of non-unions of fractures of the tibial diaphysis by posterolateral cortical cancellous bone-grafting. J Bone Joint Surg Am. 1980;62:936-41.
102. Han CS, Wood MB, Bishop AT, Cooney WP 3rd. Vascularized bone transfer. J Bone Joint Surg Am. 1992;74:1441-9.
103. Esterhai JL Jr, Sennett B, Gelb H, Heppenstall RB, Brighton CT, Osterman AL, LaRossa D, Gelman H, Goldstein G. Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posterolateral bone graft, and soft-tissue transfer. J Trauma. 1990;30:49-54.
104. Malizos KN, Zalavras CG, Soucacos PN, Beris AE, Urbaniak JR. Free Vascularized fibular grafts for reconstruction of skeletal defects. J Am Acad Orthop Surg. 2004;12:360-9.
105. Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma. 2000;14:76-85.
106. Anthony JP, Mathes SJ, Alpert BS. The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment. Plast Reconstr Surg. 1991;88:311-8.
107. Zalavras CG, Patzakis MJ, Thordarson DB, Shah S, Sherman R, Holtom P. Infected fractures of the distal tibial metaphysis and plafond: achievement of limb salvage with free muscle flaps, bone grafting, and ankle fusion. Clin Orthop Relat Res. 2004;427:57-62.
108. Weiland AJ, Moore JR, Daniel RK. The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg Am. 1984;66:181-93.
109. Siegel HJ, Patzakis MJ, Holtom PD, Sherman R, Shepherd L. Limb salvage for chronic tibial osteomyelitis: an outcomes study. J Trauma. 2000;48:484-9.