Cardiopulmonary Response to Reamed Intramedullary Nailing of the Femur Comparing Traditional Reaming With a One-Step Reamer-Irrigator-Aspirator Reaming System: An Experimental Study in Pigs

Husebye, Elisabeth Ellingsen; Lyberg, Torstein; Opdahl, Helge; Laurvik, Helene; Røise, Olav

doi:10.1097/ta.0b013e3181d27928

Cited by 28 publications

(18 citation statements)

References 39 publications

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“…Other authors have examined venting the canal during intramedullary reaming but the significance in the oncologic population has yet to be elucidated [12][13][14]. Use of the RIA in animal models has demonstrated lower numbers of pulmonary emboli and lower intramedullary pressures when compared with traditional reaming [15,16]. In our small series, 6 patients had pulmonary metastases and compromised lung function, while 5 patients had brain metastases.…”

Section: Discussionmentioning

confidence: 82%

Reamer/Irrigator/Aspirator (RIA) and Intramedullary Fixation for Impending Pathologic Femur Fracture

Munz¹,

Gale²,

Marco³

2015

TOJ

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Introduction:Pathologic femur fracture is a significant cause of pain and disability in patients with metastatic carcinoma or multiple myeloma. Treatment of these fractures with intramedullary (IM) nailing has become common practice; however, there are concerns for possible complications in these patients. The aim of this study was to evaluate the use of the Reamer/Irrigator/Aspirator (RIA) with prophylactic IM fixation of impending femur fractures. Methods: Eight patients with impending pathologic femur fractures who underwent IM fixation using RIA were retrospectively analyzed. The study analyzed the location and number of the lesions, pathology, presence of metastases to lung or brain, estimated blood loss, operative time, Mirels score, length of hospital stay, perioperative complications, and ambulation method. Results: Average Mirels score at presentation was 11. Pulmonary metastases were present in 6 and brain metastases in 5 patients. Average operative time was 62.3 minutes, and average blood loss was 212.5 ml. No intraoperative complications occurred. Average postoperative hospital stay was 9.1 days. No patients had a decline in pulmonary or neurologic status in the perioperative period. Mean follow-up time was 24.2 months. No implant failures occurred. Discussion: The use of RIA as an adjuvant therapy appears to be safe and beneficial by potentially reducing pulmonary and neurologic complications. The impending pathologic lesion with intact femoral cortices could present an ideal area of application to further minimize risks in an already compromised patient population. Keywords: Pathologic fracture; Impending fracture; Intramedullary nail; Reamer/Irrigator/Aspirator. Reamer

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Section: Discussionmentioning

confidence: 82%

Reamer/Irrigator/Aspirator (RIA) and Intramedullary Fixation for Impending Pathologic Femur Fracture

Munz¹,

Gale²,

Marco³

2015

TOJ

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“…When 2 groups of intact sheep femurs were reamed, one with a Rinsing Suction Reamer (RSR) and the other with a conventional reamer, the RSR group showed no increase in intramedullary pressure over normal physiologic values, decreased fat intravasation into the pulmonary circulation, and improved cardiac and pulmonary hemodynamics [6]. In pigs reamed with the RIA there is evidence of improved cardiopulmonary function and fewer pulmonary emboli [7]. A subsequent study by the same group found decreased pulmonary activation of coagulation and fibrinolysis in the RIA group [8].…”

Section: Acute Care Of Femur Fracturesmentioning

confidence: 99%

The Reamer-Irrigator-Aspirator: Roles and Evidence Supporting its use in Current Orthopaedic Practice

Barlow¹

2014

Surgery Curr Res

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“…21 Studies of nail placement in animals have demonstrated that the RIA device minimizes the increase in intramedullary pressure and fat intravasation associated with canal reaming. [9][10][11] Husebye et al 11 illustrated this in a sheep model by measuring intramedullary pressures at various times during the nailing of femur fractures with either the RIA device or traditional reamer. They found that pressures were signifi cantly lower during reaming with the RIA (mean, 33Ϯ8 mm Hg) than the traditional reamer (mean, 188Ϯ38 mm Hg), but there was no signifi cant difference at other points of the surgery, including nail insertion.…”

Section: C 4b 4amentioning

confidence: 99%

“…In nononcologic cases, use of the RIA device has been shown to decrease the rate of marrow intravasation and the number of pulmonary emboli compared with a standard femoral reamer. [9][10][11] The purpose of this study was to demonstrate that malignant cells could be retrieved by using a RIA during intramedullary fi xation of femoral lesions. By capturing a tumor that otherwise would have been forced into the systemic circulation, use of the RIA may decrease the risk of malignant embolization associated with this procedure.…”

mentioning

confidence: 99%

Use of the Reamer–Irrigator–Aspirator May Reduce Tumor Dissemination During Intramedullary Fixation of Malignancies

Cipriano

Arvanitis²,

Virkus³

2012

Orthopedics

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Intramedullary nail fixation is the treatment of choice for impending and pathologic fractures secondary to metastatic cancer; however, this procedure has been shown to cause systemic embolization of intramedullary contents. This article reports the use of the reamer-irrigator-aspirator (RIA) (Synthes, Paoli, Pennsylvania) instead of a standard femoral reamer to decrease tumor intravasation during femoral intramedullary nail fixation for impending or pathologic fractures.Twenty-one consecutive patients indicated for fixation of malignant femoral lesions were treated with intramedullary nail placement. The RIA was used for canal preparation, and solid reamings were collected and submitted for analysis by a single pathologist. The volume of each specimen was recorded, and representative samples were examined histologically to determine their percent tumor content. These data were then used to estimate the volume of tumor retrieved by the RIA in each case. The mean volume of reamings collected by the RIA was 75.0 cc per case (range, 23.4-196.0 cc), and the mean tumor content was 24.8% (range, 1.0%-60.0%). The mean estimated volume of tumor retrieved in each case was 16.7 cc (range, 0.35-36.0 cc). In 2 cases, the tip of the RIA dissociated from the device intraoperatively but was retrieved without adverse consequence to the patient. Use of the RIA in cases of femoral intramedullary nail fixation for pathologic lesions or fractures effectively retrieves variable amounts of intramedullary contents, including tumor. By preventing the systemic dissemination of malignant cells, this technique may reduce the risk of distant metastases.

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Cardiopulmonary Response to Reamed Intramedullary Nailing of the Femur Comparing Traditional Reaming With a One-Step Reamer-Irrigator-Aspirator Reaming System: An Experimental Study in Pigs

Cited by 28 publications

References 39 publications

Reamer/Irrigator/Aspirator (RIA) and Intramedullary Fixation for Impending Pathologic Femur Fracture

Reamer/Irrigator/Aspirator (RIA) and Intramedullary Fixation for Impending Pathologic Femur Fracture

The Reamer-Irrigator-Aspirator: Roles and Evidence Supporting its use in Current Orthopaedic Practice

Use of the Reamer–Irrigator–Aspirator May Reduce Tumor Dissemination During Intramedullary Fixation of Malignancies

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