Intramedullary nailing and reaming irrigator aspiration (RIA) autografting

Case contributed by Neel Parikshak


History of right tibia and fibula fractures complicated by infection and nonunion despite multiple washouts and antibiotic treatment. He was treated with intramedullary nailing (IMN) and reaming irrigator aspiration (RIA) autografting.

Patient Data

Age: 35-40
Gender: Male

AP and Lateral:

Bone grafting (RIA technique) is noted at the nonunion fracture site with trace periosteal new bone formation at the medial tibial cortex consistent with healing.

 An intramedullary nail is transfixed with two proximal and two distal screws and shows no evidence of hardware failure or loosening. There are old healed fracture deformities at the fibular shaft.  Mild to moderate distal diffuse osteopaenia.

Case Discussion

The “Reamer-Irrigator-Aspirator” (RIA) device provides continuous irrigation and aspiration during intramedullary reaming of long bones, as was done for this patient. The goal is to reduce intramedullary pressure during the procedure. The aspirate taken from the medullary region is found to be enriched for growth factors and stem cells, and can be used for bone grafting to promote filling of bone defects in the epiphyseal and metaphyseal regions. It can also be used in diaphyseal regions, though certain modifications must be made to the grafting procedure to ensure the graft does not disperse into the surrounding soft tissues and successfully revascularizes.

Our case demonstrates successful autografting using RIA technique. 

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center    

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