title: Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator.
abstract: BACKGROUND
  The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA) autogenous bone grafting (ABG) of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation.
  
  
  METHODS
  We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints.
  
  
  RESULTS
  Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80%) went on to union within six months and 13 (86.7%) within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA.
  
  
  CONCLUSIONS
  We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kusnezov
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
authors.forename: Gautham
authors.initials: G
authors.lastname: Prabhakar
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dallo
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Thabet
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Abdelgawad