Use of the ‘reamer irrigator aspirator’ system for non-infected tibial non-union after failed iliac crest grafting

Abstract

Autologous bone graft represents the gold standard treatment modality for managing atrophic nonunions associated with bone loss by virtue of its osteoinductive and osteoconductive properties. Traditionally, the commonest harvesting site for autologous bone graft has been the iliac crest. However, there have been concerns about iliac crest bone grafts because of limited volume and considerable donor site morbidity. Alternative autologous bone graft can be harvested from the femoral bone cavity, using a newly developed technique that combines intramedullary reaming and aspiration of the reamed content. Use of the ‘reamer irrigator aspirator’ (RIA) technique results in a voluminous amount of bone graft, which seems to be superior in growth potential to iliac crest bone graft and may therefore exceed the abilities of pelvic crest bone graft. We report a case of open tibial shaft fracture (Gustilo IIIb) with significant bone loss. After failed iliac crest bone grafting, bone graft from the femoral