More adverse events than expected in the outcome after use of the reamer-irrigator-aspirator.

Abstract

The reamer-irrigator-aspirator (RIA) system is described as having high success rates and only few complications. The RIA was originally designed to ream the intramedullary canal in a single step prior to the placement of an intramedullary nail for femur fixation. Its purpose was to collect and evacuate marrow contents during reaming to prevent embolism into the systemic circulation. Marrow evacuation is also used to stimulate healing in nonunion fractures, segmental bone defects, and osteomyelitis. Despite the described success rates, we experienced severe adverse events. Our aim was to describe these events and point out possible complications. A retrospective study of all consecutive patients treated for nonunion fractures, bone defects, or osteomyelitis from October 2007 to March 2010. All patients were treated with the RIA system. We analyzed demographic characteristics, consolidation on X-rays, time from injury to healing, complications, and postoperative pain caused by the reaming procedure. We included 32 patients (21 males) with an average follow-up of 277days. Successful healing was achieved in 66% of all patients, and 18% suffered from postoperative pain. A complication due to the use of the RIA system was registered in 31% of the patients. Recorded complications were bone defects, signs of lung embolism, a myocardial infarction, and fissure fractures. The RIA system has benefits in the treatment of nonunion and osteomyelitis defect, but is not without risk. Meticulous surgical technique is mandatory and peroperative constant monitoring of patients and the assembled device is mandatory.