title: The use of Reamer-irrigator-aspirator in the management of long bone osteomyelitis: an update.
abstract: OBJECTIVE
  Reamer-irrigator-aspirator (RIA) is an innovative device that its indications have recently been expanded to the management of long bone infections.
  
  
  METHODS
  In this narrative review, we summarise the most important studies in the field and we present the current open questions pertaining to the use of RIA in the management of osteomyelitis of long bones.
  
  
  RESULTS
  The relevant literature is sparse and low quality. Nevertheless, the use of RIA for infected cases has yielded promising outcomes in specialised centres. Technical aspects that merit special attention in osteomyelitis of long bones are its inapplicability in small diameter long bones, the inadequate debridement of wide metaphyseal areas and the potential bleeding sequelae. The use of RIA in open fracture management to reduce infection risk has not gained acceptance. The antibiotic impregnated nails and rods constitute a complimentary strategy for the management of infections.
  
  
  CONCLUSIONS
  The use of RIA for the management of long bone infections is an innovative and promising strategy. High quality studies are needed to shed light in its efficacy compared to conventional methods of management of osteomyelitis of long bones.
authors.affiliation: Academic Department of Trauma and Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK.|NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, LS7 4SA, UK.
authors.forename: T H
authors.initials: TH
authors.lastname: Tosounidis
authors.affiliation: G. Pini Institute, University of Milan, Piazza Cardinal Ferrari 1, Milan, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Calori
authors.affiliation: Academic Department of Trauma and Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK. pgiannoudi@aol.com.|NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, LS7 4SA, UK. pgiannoudi@aol.com.
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D003646:Debridement / Q000295:instrumentation*; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D010019:Osteomyelitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation; D016896:Treatment Outcome
keywords: Infection; Long bones; Osteomyelitis; Panmedullary sepsis; RIA; Reamer–irrigator–aspirator; Reaming