REAMER IRRIGATION ASPIRATOR (RIA) FOR BONE GRAFT HARVEST: APPLICATIONS FOR GRAFTING LARGE SEGMENTAL DEFECTS IN THE TIBIA AND FEMUR

Abstract

This study documents the use of bone graft harvested by the RIA system and used in treating segmental bone loss in the femur and tibia following trauma.

Eight patients with segmental defects of the tibia or femur were enrolled in the study. The segmental defects were optimized for bone grafting by repeated debridements and muscle flap coverage as required. Graft was harvested from the ipsilateral femur via a percutaneous technique. Volumes of bone graft were recorded and then placed to the defect site during the same surgical procedure.

The average age of the patients was twenty-nine years (sixteen to forty-one years). In the five tibiae and three femora there were four grade IIIA, three grade IIIB and One grade IIIC injuries. Muscle flap coverage was required in four patients. The average size of defect was 7 cm (1–14.5 cm). The RIA grafting was performed at an average of three months (2.5 – 5 months) post injury. The average bone graft volume obtained was 73cc(45–90 cc). The average hemoglobin drop was 4.4g/dl(2.3 – 8.0 g/dl) and the average hematocrit drop was 12.3%(6–21%). One patient required transfusion. Donor site complications were limited to one post-operative bleed. Defect site complications included one wound dehiscence and two infections. Radiographic union of the defects was achieved at an average time of four months (two to twelve months).

Grafting of large segmental defects using RIA bone graft has resulted in union at an average of four months. This technique represents an alternative to bone transport for treatment of segmental defects.

Reamed Irrigation Aspirator (RIA) allows access to large volumes of bone graft from the femur through percutaneous technique. The grafting technique was utilized to obtain graft for eight segmental defects in the tibia and femur. These healed at an average of four months.