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. 2022 Oct 4;14(4):37889.
doi: 10.52965/001c.37889. eCollection 2022.

The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review

Marco Landrino  1 , Riccardo Luigi Alberio  2 , Alice Clemente  1 , Federico Alberto Grassi  3
Affiliations

The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review

Marco Landrino et al. Orthop Rev (Pavia). .

Abstract

Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures. Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union. The Reamer-Irrigator-Aspirator (RIA) System® was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature. In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed. Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.

Keywords: aseptic nonunion; autologous bone graft; fracture nonunion; reamer-irrigator-aspirator; ria system.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.

  1. Comminuted supracondylar fracture of the right femur in a 35-year old man.

  2. Postoperative radiographs after internal fixation with plate and screws; synthetic bone chips were used to fill a bone defect in the postero-medial region (arrows)

Figure 2.
Figure 2.

  1. One year after index procedure: freshening of the nonunion site with insertion of a tricortical autograft from the iliac crest and morselized cancellous allograft.

  2. Two years after index procedure: persistent nonunion with plate rupture.

Figure 3.
Figure 3.

  1. Postoperative control after plate revision and nonunion grafting with morselized bone harvested with the RIA System.

  2. X-rays showing bone union 10 months after the RIA procedure.

Figure 4.
Figure 4.. Hip and Knee ROM two years after last surgery (four years from trauma).
Figure 5.
Figure 5.

  1. Multifragmentary subtrochanteric fracture of the right femur in a 27-year old man (case 2).

  2. Unsatisfactory reduction and fixation with a cephalomedullary nail (see text for details).

  3. Early revision with shortening of the femur and cerclage of a diaphyseal fragment.

Figure 6.
Figure 6.

  1. Nonunion with nail breakage (arrowheads) 7 months after index procedure.

  2. Revision osteosynthesis with plate and morselized bone graft harvested with the RIA System.

Figure 7.
Figure 7.. Radiograms showing bone union one year after the RIA procedure.
Figure 8.
Figure 8.. Hip and Knee ROM two years after last surgery (31 months from trauma).
Figure 9.
Figure 9.. Flowchart for the selection of studies included in the review.
See this image and copyright information in PMC

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References

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