ABSTRACT
The "Reamer-Irrigator-Aspirator" (RIA) is a device that provides continuous irrigation and aspiration during intramedullary reaming of long bones. The RIA system is first used to collect the reaming material from medullary cavities, a thick paste of finely morselized osseous particles containing significantly elevated levels of stem cells and growth factors as reported by quantitative analyses. The volume of bone graft material available from an adult femur corresponds to the amount of cancellous bone graft obtained from both the anterior and posterior iliac crests. The assembly and technicalities of the RIA system require a training period to prevent any femoral fracture, which appears to be the major RIA-related complication. The elective indications for RIA bone grafting are filling of bone defects in the epiphyseal and metaphyseal regions. Diaphyseal defects may also be managed using the RIA system provided the graft is placed in a constrained system (induced membrane) to prevent dispersion of the graft into the surrounding soft tissues and is aerated with a porous material to promote its revascularization. Other RIA indications include debriding intramedullary infections and reaming for intramedullary nailing of long bone fractures to reduce the risk of fat embolization.
Subject(s)
Bone Transplantation/methods , Femur/transplantation , Fracture Fixation, Intramedullary/methods , Fractures, Bone/surgery , Tissue and Organ Harvesting/instrumentation , Equipment Design , Humans , Therapeutic Irrigation/instrumentationABSTRACT
We randomized 103 patients over the age of 50 with an unstable closed intra- or extra-articular dorsally displaced distal radius fracture to have either palmar fixed-angle plating (n=50) or 'mixed pinning' (n=53) and compared the clinical and radiological outcomes at 3, 6, 12 and 26 weeks after surgery in a prospective study. Postoperative palmar tilt was significantly better in those stabilized with K-wires, but loss of reduction was statistically less in those stabilized with a plate. At 26 weeks, functional results, assessed by DASH and Herzberg scores, were better in those fixed with a plate.