8/13/2019 CUBON_1
1/2
REACTION:
The RIA device has distinct features that appear to be
beneficial for the management of
intramedullary infections. In contrast to conventional reamers,
the RIA device allows reaming under
simultaneous irrigation and aspiration, which minimizes the
residual amount of infected fluid and
tissue in the medullary canal and the propagation of infected
material along the distal end of the
medullary canal, into the surrounding bone and into the
circulation. This leads, in our opinion, to
more effective debridement and irrigation that may facilitate
control of infection. In addition, the
reamer head is disposable and always sharp in contrast to
conventional ones, which are used multiple
times and become blunt over time leading to generation of
increased temperature during reaming.
Therefore, the sharp reamer head combined with the continuous
irrigation may attenuate the
increased temperature associated with reaming, and its potential
adverse effects on the adjacent
endosteal bone. This may result in increased preservation of
endosteal bone viability that would be
beneficial in cases of intramedullary infections in order to
resist reinfection by any residual
microorganisms. Therefore, the RIA device has the potential to
minimize problems associated with
conventional reamers and to improve the efficacy of the reaming
procedure. The current limited
literature appears promising but in the only clinical series
there was no control group and no
comparison of the RIA device to conventional reamers was
performed. Therefore, it remains unclearif the advantageous
features of the RIA device translate to improved outcome of long
bone
intramedullary infections. A prospective, randomized
multi-center study would be the ideal
investigation to clarify this issue. The main disadvantage of
the RIA device is the increased cost
because of the use of disposable parts. Complications directly
associated with use of the RIA for
debridement of intramedullary infections have not been reported
in the small number of patients
reported in the literature. However, the use of the RIA for
other applications has resulted in
complications, such as iatrogenic fractures.
These complications can be avoided by paying close attention to
the indications, contraindications,
planning, and execution of the procedure. In conclusion, the RIA
device appears to be an effective,
safe, and useful tool for debridement of the medullary canal and
management of intramedullary
infections of the long bones. Further research is needed to
clarify the exact contribution of the RIA inthe management of these
challenging infections.
DOMINO, NIKKI Y. 4 ACN GROUP 1-B
