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

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2012.665332 In 2009, a 26-year-old man presented at his local hospital with a closed displaced mid-shaft clavicle fracture following a fall from his mountain bike. There was no neurovascular compromise. He underwent open reduction and internal fixation of the clavicle 1 week later, with an anterior reconstruction plate. The wound healed with no signs of infection. 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). The closed double-lumen suction irrigation system was constructed by threading an epidural catheter through the connector of an intravenous giving set (the connecting pipe to a