title: The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods.
abstract: Intramedullary infection in long bones represents a complex clinical challenge, with an increasing incidence due to the increasing use of intramedullary fixation. We report a prospective case series using an intramedullary reaming device, the Reamer-Irrigator-Aspirator (RIA) system, in association with antibiotic cement rods for the treatment of lower limb long bone infections. A total of 24 such patients, 16 men and eight women, with a mean age of 44.5 years (17 to 75), 14 with femoral and 10 with tibial infection, were treated in a staged manner over a period of 2.5 years in a single referral centre. Of these, 21 patients had had previous surgery, usually for fixation of a fracture (seven had sustained an open fracture originally and one had undergone fasciotomies). According to the Cierny-Mader classification system, 18 patients were classified as type 1A, four as 3A (discharging sinus tract), one as type 4A and one as type 1B. Staphylococcus species were isolated in 20 patients (83.3%). Local antibiotic delivery was used in the form of impregnated cement rods in 23 patients. These were removed at a mean of 2.6 months (1 to 5). Pathogen-specific antibiotics were administered systemically for a mean of six weeks (3 to 18). At a mean follow-up of 21 months (8 to 36), 23 patients (96%) had no evidence of recurrent infection. One underwent a planned trans-tibial amputation two weeks post-operatively due to peripheral vascular disease and chronic recalcitrant osteomyelitis of the tibia and foot. The combination of RIA reaming, the administration of systemic pathogen-specific antibiotics and local delivery using impregnated cement rods proved to be a safe and efficient form of treatment in these patients.
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kanakaris
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gudipati
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
authors.forename: T
authors.initials: T
authors.lastname: Tosounidis
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Harwood
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Britten
authors.affiliation: University of Leeds, School of Medicine, Academic Department of Trauma and Orthopaedics, 21 Cricketers Fold, Shadwell, Leeds, LS17 8WE, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000295:instrumentation* / Q000379:methods; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cement nail; Intramedullary Sepsis; Osteomyelitis; RIA; Reaming