title: More adverse events than expected in the outcome after use of the reamer-irrigator-aspirator.
abstract: OBJECTIVE
  The reamer-irrigator-aspirator (RIA) system is described as having high success rates and only few complications. The RIA was originally designed to ream the intramedullary canal in a single step prior to the placement of an intramedullary nail for femur fixation. Its purpose was to collect and evacuate marrow contents during reaming to prevent embolism into the systemic circulation. Marrow evacuation is also used to stimulate healing in nonunion fractures, segmental bone defects, and osteomyelitis. Despite the described success rates, we experienced severe adverse events. Our aim was to describe these events and point out possible complications.
  
  
  METHODS
  A retrospective study of all consecutive patients treated for nonunion fractures, bone defects, or osteomyelitis from October 2007 to March 2010. All patients were treated with the RIA system. We analyzed demographic characteristics, consolidation on X-rays, time from injury to healing, complications, and postoperative pain caused by the reaming procedure.
  
  
  RESULTS
  We included 32 patients (21 males) with an average follow-up of 277 days. Successful healing was achieved in 66 % of all patients, and 18 % suffered from postoperative pain. A complication due to the use of the RIA system was registered in 31 % of the patients. Recorded complications were bone defects, signs of lung embolism, a myocardial infarction, and fissure fractures.
  
  
  CONCLUSIONS
  The RIA system has benefits in the treatment of nonunion and osteomyelitis defect, but is not without risk. Meticulous surgical technique is mandatory and peroperative constant monitoring of patients and the assembled device is mandatory.
authors.affiliation: Department of Traumatology, Albert Schweitzer Hospital, Albert Scheitzerplaats 25, 3318 AT, Dordrecht, The Netherlands. tscjakma@hotmail.com.
authors.forename: T S C
authors.initials: TS
authors.lastname: Jakma
authors.affiliation: Department of Traumatology, Albert Schweitzer Hospital, Albert Scheitzerplaats 25, 3318 AT, Dordrecht, The Netherlands. maartenroling@hotmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Röling
authors.affiliation: Department of Traumatology, Albert Schweitzer Hospital, Albert Scheitzerplaats 25, 3318 AT, Dordrecht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Punt
authors.affiliation: Department of Traumatology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Reynders-Frederix
keywords: Adverse event; Complication; RIA; Reamer-irrigator-aspirator
references.citation: Orthop Traumatol Surg Res. 2012 Apr;98(2):227-32
references.pmid: 22402294
references.citation: Injury. 2013 Oct;44(10):1263-9
references.pmid: 23845569
references.citation: Injury. 2008 Jul;39(7):796-800
references.pmid: 18541244
references.citation: J Orthop Trauma. 2010 Jan;24(1):46-52
references.pmid: 20035178
references.citation: Orthop Clin North Am. 2010 Jan;41(1):95-8; table of contents
references.pmid: 19931057
references.citation: J Orthop Res. 2009 Jan;27(1):42-9
references.pmid: 18655129
references.citation: Orthop Clin North Am. 2010 Jan;41(1):63-73; table of contents
references.pmid: 19931054
references.citation: J Orthop Trauma. 2007 May;21(5):343-6
references.pmid: 17486000
references.citation: J Orthop Trauma. 2011 Feb;25(2):e12-4
references.pmid: 21245702
references.citation: Injury. 2010 Nov;41 Suppl 2:S43-7
references.pmid: 21144927
references.citation: Orthop Clin North Am. 2010 Jan;41(1):99-103; table of contents
references.pmid: 19931058
references.citation: Int Orthop. 2011 Jul;35(7):951-6
references.pmid: 21243358
references.citation: Injury. 2010 Nov;41 Suppl 2:S72-7
references.pmid: 21144933
references.citation: Clin Orthop Relat Res. 2007 Aug;461:31-4
references.pmid: 17514012
references.citation: Injury. 2009 Nov;40(11):1231-6
references.pmid: 19783249
references.citation: Bone. 2005 Jan;36(1):74-83
references.pmid: 15664005
references.citation: Injury. 2010 Nov;41 Suppl 2:S51-6
references.pmid: 21144929
references.citation: Clin Orthop Relat Res. 2008 Dec;466(12 ):2973-80
references.pmid: 18841433