title: Reamer Irrigator Aspirator bone graft harvesting: complications and outcomes in an Asian population.
abstract: BACKGROUND
  Autologous bone grafting has been accepted as the gold standard in the treatment of non-unions and in definitive filling of segmental bone defects. However, there have been well-recognised complications associated with their harvest. The Reamer Irrigator Aspirator (RIA) system is an alternative technique of autologous bone graft harvesting. Studies have been published in the Western population showing the efficacy and outcome of this technique. No prior studies were done in the Asian population, who has smaller average canals, different femoral geometry as compared to Caucasians and weaker bone density in both genders. We aim to present the findings and discuss its suitability in the Asian population when dealing with segmental bone loss and non-unions requiring reconstruction.
  
  
  METHODS
  We conducted a retrospective analysis of all trauma patients with segmental bone loss and non-unions treated with RIA bone grafting over a 4.5 year period. A total of 57 cases of RIA bone grafting were conducted on 53 patients. The amount of bone graft harvested, blood loss and post-operative pain were measured. Patients were followed up for union rate as well as complications of the procedure.
  
  
  RESULTS
  Union was achieved in 86.8% of patients. The mean time to union was 17.64 weeks. Seven patients did not achieve union after the first RIA surgery, in which six of seven were open fractures initially and six were smokers. One major intra-operative complication was recorded, that being a fractured femoral shaft due to thinning of the cortex by the RIA harvester. There were two patients who developed donor site superficial soft tissue infection that resolved after a course of antibiotics. There were no long-term complications seen in all patients.
  
  
  CONCLUSIONS
  The safety and efficacy of RIA bone graft harvesting for the management of non-union in the Asian population is promising, with adequate graft quantities, high success and low complication rates that are comparable to the Caucasian population. The diameter of the medullary canal in our population is suitable for this procedure. We believe that RIA bone graft harvesting provides a reliable and safe alternative source of autologous bone grafts for bone grafting of non-union sites.
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore. Electronic address: fucai_han@nuhs.edu.sg.
authors.forename: Fucai
authors.initials: F
authors.lastname: Han
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Luke
authors.initials: L
authors.lastname: Peter
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Eugene Tze Chun
authors.initials: ET
authors.lastname: Lau
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Joseph
authors.initials: J
authors.lastname: Thambiah
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore, Singapore; Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore.
authors.forename: Fareed Husain Yusuf
authors.initials: FH
authors.lastname: Kagda
mesh_terms: D044466:Asian People; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016025:Bone Transplantation; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D007507:Therapeutic Irrigation; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
keywords: Asian population; Bone graft harvesting; Complications and outcomes of bone graft harvesting; Management of non-union; Reamer Irrigator Aspirator