title: A new technique for removing intramedullary cement.
abstract: Treatment of infected long bone fractures or nonunions requires stability for bony union, yet retained implants can lead to persistent infection. Antibiotic cement intramedullary nails, in addition to external fixation, are commonly used to deliver intramedullary antibiotics in infected long bone fractures and provide temporary stability. However, the retrieval of these nails can result in debonding of antibiotic cement, which can require significant time and effort to remove. A variety of methods, including intramedullary hooks, reverse curettes, flexible osteotomes, and stacked guide rods, are commonly used to remove cement fragments. When these methods fail to allow access to the entire length of the canal, the Reamer Irrigator Aspirator system (Synthes, Paoli, PA) serves as an effective method for removing retained intramedullary cement. The surgical technique is described, and three cases illustrate the successful use of the Reamer Irrigator Aspirator system for removal of an antibiotic cement intramedullary nail.
authors.affiliation: Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65212, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Lowe
authors.forename: Caleb
authors.initials: C
authors.lastname: Vosburg
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Murtha
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Della Rocca
authors.forename: Brett D
authors.initials: BD
authors.lastname: Crist
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001843:Bone Cements / Q000737:chemistry* / Q000494:pharmacology; D001858:Bone Nails; D002484:Cementation / Q000379:methods; D003646:Debridement; D020878:Device Removal / Q000295:instrumentation* / Q000379:methods; D004337:Drug Carriers; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D013396:Suction; D007507:Therapeutic Irrigation / Q000295:instrumentation* / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004337:Drug Carriers