We describe our medium-term results for the management of chronic osteomyelitis in long bones using the Lautenbach procedure. Seventeen consecutive patients (18 segments) were treated prospectively. Osteomyelitis had been present for a mean of 12.5 years (1 to 31). A discharging sinus was present in all cases. Nine of the associated fractures had failed to unite and a further two needed correction of malunion. The Lautenbach procedure involves debridement, intramedullary reaming and the insertion of double-lumen tubes to establish both a local antibiotic delivery system and cavity analysis for volume and culture. The end-point of treatment is when the irrigate produces three consecutive clear cultures with improvement in the blood indices and obliteration of the cavity volume. The mean length of treatment was 27 days (14 to 48). One patient required a second procedure and another local debridement for recurrence of the infection. Two patients had Papineau grafting because of cortical defects. All the patients have subsequently remained free from infection. After treatment 11 had internal or external fixation for treatment of non- or malunion or a joint replacement, including two successful limb-lengthening procedures. Two further patients, while cured of infection, underwent amputation for other reasons. The mean length of follow-up was 75 months. This procedure allows precise control over the osteomyelitis until objective assessment suggests that infection has been cleared and the cavity obliterated. We recommend this procedure for long-standing complex cases in which basic techniques using debridement and antibiotics have failed.
To evaluate the medium term results of the Lautenbach procedures for the treatment of chronic osteomyelitis [COM] in long bones. Cohort of 17 patients (18 segments) prospectively treated. Mean age 37 years. High-energy trauma effecting 8 tibia (6 open) &
9 femora (5 open). Duration of COM was mean 12. 5 years (1–31 years). Discharging sinus present in all. Lautenbach procedure comprises intramedullary reaming/debridement to 13 mm and establishment of local antibiotic delivery system, cavity analysis for volume and culture. The end point is 3 clear culture results of the irrigate, improvement in blood indices and reduction of cavity volume. Mean treatment time 27 days (14–48). Mean hospital stay 38 days. Two needed revision of Lautenbach procedure and one local debridement for recurrence of infection. 7 non-unions needed further fixation. 2 needed Papineau grafting and 3 had further limb lengthening procedures. Mean follow-up is 3. 3 years. 4 patients have been discharged, 1 awaiting THR. This procedure permits precise control over the osteomyelitis cavity until objective assessment suggests that infection has been cleared and cavity obliterated.
To evaluate the effects of smoking on fracture healing in a non-union population. A consecutive cohort of 104 patients with 107 non-unions managed by external fixation was reviewed. 75% were regular smokers compared to the regional average of 3 0%. 5 8 male and 20 female smokers, matched with the non-smoking group. Patients’ records and x-rays were evaluated; where information was missing patients were contacted by phone/post. Scoring was recorded from our own prospective database. The smokers underwent 2. 6 procedures per segment with a mean treatment time of 17. 43 months (4–64) compared to 1. 9 and 10. 9 (2. 5–24) respectively in non-smoking group. The total hospital stay was 66% greater in the smoking group (41. 12 vs 27. 4 days). 102 non-unions healed, including seven who required revision surgery, six of whom were smokers. In smoking group five went on to amputation and three had residual infection. The entire non-smoking group healed after primary surgery except a 70 years old lady who was converted to intramedullary nailing. The final assessment of the bony and functional results was performed by the method described by Paley and Catagni (JBJS 77A 1995).
When considered in the context of regional statistics for smoking there was a trend towards non-union in smokers [P<
0. 05]. When limb reconstruction treatment was compared between the two groups despite the low number of infected cases in the smoking group, the number of surgical procedures, duration of treatment and hospital stay were all increased. Failure, revision rate and residual infection were high in the smoking groups. We conclude that smoking adversely affects both primary fracture healing and non-union treatment.
