Landrino Marco, Alberio Riccardo Luigi, Clemente Alice, Grassi Federico Alberto
Department of Health Sciences, University of East Piedmont, Novara (Italy).
Orthopaedic and Traumatology, Hospital "Maggiore della Carità", Novara (Italy).
Orthop Rev (Pavia). 2022 Oct 4;14(4):37889. doi: 10.52965/001c.37889. eCollection 2022.
Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures. Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union. The Reamer-Irrigator-Aspirator (RIA) System® was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature. In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed. Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.
股骨干骨不连是骨折的致残性并发症，具有相关的社会经济和心理影响。股骨干骨不连的发生率不可忽视，髓内钉固定后发生率在1%至10%之间，但转子下骨折时可超过20%。治疗方案受病理力学、解剖学和临床因素影响。肥大性骨不连通常通过增强固定稳定性来治疗，而萎缩性骨不连需要额外的生物刺激以实现骨愈合。研发扩髓-冲洗-吸引（RIA）系统®是为了降低髓内扩髓时的髓内压力和热量产生，从而防止热坏死并降低脂肪栓塞风险。RIA系统能够提供大量高质量的碎骨自体骨，其已显示出高成骨和骨诱导特性。因此，其应用已扩展为治疗不同性质大骨缺损的有价值的自体骨移植来源。在本文中，我们展示了两例使用RIA系统治疗的复杂股骨干骨不连病例。我们还对已发表的关于使用RIA治疗股骨干骨不连的文献进行了综述。核心提示：对于萎缩性骨不连，RIA系统可用于获取生物活性组织以促进骨愈合。尽管缺乏专注于股骨干骨不连的高质量研究，但RIA的疗效是众所周知的，骨科医生应了解这一强大工具。
