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Modified Lautenbach technique in the treatment of an open infected non-union of the clavicle--a case report.

Johnson B, Thomas P, McClelland D - Acta Orthop (2012)

View Article: PubMed Central - PubMed

Affiliation: The Trauma and Orthopaedic Department, University Hospital of North Staffordshire, Stoke on Trent, UK. bjohnso25@yahoo.co.uk

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The Lautenbach technique, the use of a closed double-lumen suction irrigation system, generally involves intramedullary placement of the irrigation tubes... At 6 months postoperatively, he had regained full motion in his shoulder and radiographs showed union of the fracture (Figure 5) Deep infection after internal fixation of clavicle fractures is associated with a poor rate of union and poor functional outcome. described 1 deep infection in 232 plated clavicle fractures. reported 8 infections in 103 cases treated with plate fixation. 5 of these were deep infections... Deep infections following open reduction and internal fixation of clavicle fractures will become more common, as a greater proportion of clavicle fractures are being treated surgically... It also allows obliteration of the dead space created by soft tissue and bone debridement... There have been no previous publications in which the Lautenbach technique has been used in the management of infected non-unions of the clavicle... We used a modified Lautenbach technique, as the clavicle cannot be reamed in the same way as the tibia and femur to accommodate the irrigation tubes, which are traditionally inserted in an intramedullary fashion... Instead, the end of the double-lumen suction irrigation system was placed at the fracture site, allowing local delivery of antibiotics and antithrombotic agents. and used the suction irrigation system for approximately 3 weeks... We removed the double-lumen tube on day 7, as the inflammatory markers had markedly improved and the patient was suitable for discharge with appropriate oral antibiotic treatment... Deep infection of the clavicle will become increasingly common, as clavicle fractures are more often being treated by open reduction and internal fixation... We believe that the use of a modified Lautenbach system in conjunction with external fixation may be of value in the management of infected clavicle non-unions.

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Pennig external fixator and Lautenbach drain emerging from the closed wound.
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Figure 3: Pennig external fixator and Lautenbach drain emerging from the closed wound.

Mentions: 14 months after fixation, ulceration developed over the plate, which was removed and the wound was debrided and closed. 1 week later, he tripped from a standing height and landed on the same shoulder. Radiographs revealed non-union and osteopenia, and the ends of bone were protruding through the skin (Figure 1 and 2). The white cell count was 13, the CRP was 57, and the ESR was 15. The wound was debrided and treatment with intravenous benzylpenicillin (1.2 g) and flucloxacillin (2 g) was begun. He was referred on to our unit and was again operated on. The bone ends were again debrided and dead tissue excised. The bone ends were opposed and a Pennig external fixator (Orthofix, Srl, Italy) applied with 2 medial and 2 lateral pins (Figure 3). The Lautenbach technique, the use of a closed double-lumen suction irrigation system, generally involves intramedullary placement of the irrigation tubes. However, as it is not possible to ream the clavicle to a sufficient diameter to allow this, we used a modification of the Lautenbach technique and left the end of the irrigation tube at the fracture site (Figure 3).


Modified Lautenbach technique in the treatment of an open infected non-union of the clavicle--a case report.

Johnson B, Thomas P, McClelland D - Acta Orthop (2012)

Pennig external fixator and Lautenbach drain emerging from the closed wound.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369162&req=5

Figure 3: Pennig external fixator and Lautenbach drain emerging from the closed wound.
Mentions: 14 months after fixation, ulceration developed over the plate, which was removed and the wound was debrided and closed. 1 week later, he tripped from a standing height and landed on the same shoulder. Radiographs revealed non-union and osteopenia, and the ends of bone were protruding through the skin (Figure 1 and 2). The white cell count was 13, the CRP was 57, and the ESR was 15. The wound was debrided and treatment with intravenous benzylpenicillin (1.2 g) and flucloxacillin (2 g) was begun. He was referred on to our unit and was again operated on. The bone ends were again debrided and dead tissue excised. The bone ends were opposed and a Pennig external fixator (Orthofix, Srl, Italy) applied with 2 medial and 2 lateral pins (Figure 3). The Lautenbach technique, the use of a closed double-lumen suction irrigation system, generally involves intramedullary placement of the irrigation tubes. However, as it is not possible to ream the clavicle to a sufficient diameter to allow this, we used a modification of the Lautenbach technique and left the end of the irrigation tube at the fracture site (Figure 3).

View Article: PubMed Central - PubMed

Affiliation: The Trauma and Orthopaedic Department, University Hospital of North Staffordshire, Stoke on Trent, UK. bjohnso25@yahoo.co.uk

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The Lautenbach technique, the use of a closed double-lumen suction irrigation system, generally involves intramedullary placement of the irrigation tubes... At 6 months postoperatively, he had regained full motion in his shoulder and radiographs showed union of the fracture (Figure 5) Deep infection after internal fixation of clavicle fractures is associated with a poor rate of union and poor functional outcome. described 1 deep infection in 232 plated clavicle fractures. reported 8 infections in 103 cases treated with plate fixation. 5 of these were deep infections... Deep infections following open reduction and internal fixation of clavicle fractures will become more common, as a greater proportion of clavicle fractures are being treated surgically... It also allows obliteration of the dead space created by soft tissue and bone debridement... There have been no previous publications in which the Lautenbach technique has been used in the management of infected non-unions of the clavicle... We used a modified Lautenbach technique, as the clavicle cannot be reamed in the same way as the tibia and femur to accommodate the irrigation tubes, which are traditionally inserted in an intramedullary fashion... Instead, the end of the double-lumen suction irrigation system was placed at the fracture site, allowing local delivery of antibiotics and antithrombotic agents. and used the suction irrigation system for approximately 3 weeks... We removed the double-lumen tube on day 7, as the inflammatory markers had markedly improved and the patient was suitable for discharge with appropriate oral antibiotic treatment... Deep infection of the clavicle will become increasingly common, as clavicle fractures are more often being treated by open reduction and internal fixation... We believe that the use of a modified Lautenbach system in conjunction with external fixation may be of value in the management of infected clavicle non-unions.

Show MeSH
Related in: MedlinePlus