Thurs., 10/18/07 Reconstruction, Paper #16, 4:51 pm OTA-2007
Treatment of Large Segmental Bone Defects with Reamer-Irrigator-Aspirator Bone Graft
Todd McCall, MD1 (a-Synthes); Timothy Weber, MD1 (a-Synthes);
David Brokaw, MD1 (a-Synthes); Bradley Jelen, DO1 (a-Synthes);
D. Kevin Scheid, MD1 (a-Synthes); Angela Scharfenberger, MD1 (a-Synthes);
James Green, BS2 (e-Synthes); Melanie Watts, BS1 (a-Synthes);
Dean Maar, MD1 (a-Synthes); Marcus Stone, PhD1 (a-Synthes);
1OrthoIndy, Indianapolis, Indiana, USA;
2Synthes, Paoli, Pennsylvania, USA
Purpose: Treatment of large segmental defects with autogenous iliac crest bone graft can be limited by source and morbidity. The reamer-irrigator-aspirator (RIA) technique allows access to a large volume of bone graft. The purpose of this study is to evaluate the effectiveness of RIA-harvested autogenous bone graft for the treatment of large segmental defects of long bones.
Methods: Twenty-one patients (average age, 30.7 years) with segmental defects 2 to 14.5 cm (average, 6.6 cm) receiving RIA bone graft were included. One patient was lost to follow-up. The remaining 20 patients included 16 polytraumas, 8 smokers, and Gustilo classifications of 3A (n = 8), 3B (n = 9), 3C (n = 2), and 1 closed crush injury. The RIA was passed through the femoral or tibial canal and aspirated fluid was filtered to harvest cancellous bone graft, which was placed into defect site. Donor and defect-site complications as well as clinical and radiographic healing were recorded.
Results: Five femurs, 14 tibias, and 1 ulna defect were grafted. 18 of the 20 patients had polymethylmethacrylate spacers in defect prior to bone graft. 16 patients were treated with plates and 4 were treated with nails. 17 of 20 patients (85%) completely healed at an average 11 months (range, 2.5-39). 10 of these 17 (58%) healed with no additional surgery after RIA bone graft. Seven patients needed additional surgeries after original RIA. Two patients healed after exchange nail, one patient developed deep infection but healed after irrigation and débridements (I&D) and repeat RIA, one tibia healed after revision compression plating and cancellous bone graft from distal femur, one healed after I&D and Enders rod placement, one healed after repeat I&Ds, and one developed deep infection after defect healed, requiring I&D and plate removal. 10 of 20 patients had graft-site complications including 4 nonunions and 6 deep infections. There were no donor-site complications. Three patients (16%) were considered failed—two deep infections requiring removal of RIA bone graft, and one recurrent nonunion with hardware failure.
Conclusions and Significance: RIA-harvested bone graft offers a viable alternative for the treatment of segmental defects with complication and union rates similar to bone transport or conventional autogenous graft. No donor-site morbidity was observed with RIA.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.