Sat., 10/6/12 General Interest, PAPER #97, 1:21 pm OTA-2012
Six Years’ Experience With the Reamer-Irrigator-Aspirator: Impact on Healing and Pulmonary Complications Rates in Femoral Shaft Fractures
Anthony J. Bell, MD; Pratik P. Desai, MD; Michael Suk, MD, JD, MPH;
University of Florida College of Medicine–Jacksonville, Department of Orthopaedic Surgery, Jacksonville, Florida, USA
Background/Purpose: Sequentially reamed, locked intramedullary nails are the standard of care for femoral diaphysis fractures. The reamer-irrigator-aspirator (RIA) has been theorized to minimize known perioperative pulmonary complications of sequentially reamed intramedullary nails such as fat embolism syndrome (FES) and acute respiratory distress syndrome (ARDS) in the polytraumatized patient. It has been postulated that while using the RIA system may have a protective effect for the trauma patient, there may be a deleterious effect on bone healing versus conventional reaming due to aspiration of osteogenic cells and material. This study was conducted to report on healing and pulmonary complication rates of femur fractures treated using the RIA system versus conventional sequential reaming prior to the insertion of intramedullary nails.
Methods: A retrospective study was conducted comparing conventional sequentially reamed nailing for femur fractures versus those treated with the RIA. From January 2005 through December 2010, 422 patients who met inclusion criteria were treated at our Level I trauma center with an intramedullary nail by one of three fellowship-trained orthopaedic trauma surgeons. There were 283 patients with 291 femur fractures treated with conventional reaming (group A), and 139 patients with 147 femur fractures treated with the RIA (group B). The main outcome measures included rate of pulmonary complications including ARDS, pneumonia, ventilatory failure, overall pulmonary complications, days on ventilator, length of hospital stay, healing rate, and death.
Results: No significant differences were found between groups with regard to patient demographics, ISS, the incidence of head/chest trauma, time to surgery, surgical time, or the distribution of fractures according to the OTA femur fracture classification. In addition, no differences were found in length of hospital stay, length of ICU stay, or time on mechanical ventilation. Overall pulmonary complications occurred in 19% (group A) and 23% (group B), respectively (P = 0.47). Two fatalities were found in group A with four in group B (P = 0.18). A significant difference was found in healing rates between the groups with higher rates of delayed union and nonunion in the RIA group. Overall healing complications were seen in 3% and 11% of patients (P = 0.002) in groups A and B, respectively.
Conclusion: No statistical significance was reached with regard to pulmonary complications or death. We were unable to demonstrate a favorable pulmonary effect with RIA use compared to conventional reaming as has been described in previous animal studies. We found a significant difference increase in healing complications in the RIA group as compared to the sequential reaming group.
Alphabetical Disclosure Listing (808K PDF)
• 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. Δ OTA Grant.