Abstract
Introduction
Reaming of the canal is an important step in the debridement phase of treating intramedullary infections. Numerous techniques of radical canal debridement have been successfully reported. The use of the Reamer-Irrigation-Aspiration system (RIA-Synthes) is currently expanding to include this clinical scenario.
Materials and methods
Prospective collection of data related to infected cases treated with the use of the RIA in a tertiary referral centre referring to a 3 year period. Peri-operative details, microbiology results, and follow-up outcome over a minimum period of 12 months post-surgery are reported.
Results
Twenty patients (13 men), with average age 44.8 years (18–75), suffering from 7 tibial and 13 femoral infections represent the study cohort. There were 19 surgical-site-infections, and 1 spontaneous haematogenous infection in non-previously operated extremity. The canal was stabilised using an antibiotic-loaded-cement-nail in 18 cases. The antibiotic nail was subsequently removed after 6–8 weeks. The most commonly isolated organism was staphylococcus aureus. There were followed-up regularly (2,6, 12 weeks, and then at 6 months and 12, 24, 36 months). At 6 months follow up (range 12–43 months) no recurrence was observed. Two patients died during the course of the study. One patient at the day after surgery due to septic shock, and another one at 2 years due to irrelevant causation. Another patient had a below knee amputation after debriding of the canal for pan-medullary osteomyelitis. However, there was no recurrence in the stump at the latest follow up after 1 year.
Conclusion
The usage of this new device shows promising results in the treatment of intramedullary osteomyelitis. Reaming under simultaneous irrigation and suction appears to be an effective and safe alternative for debridement of the intra medullary infections of femur and tibia. Long term follow up is essential, as post traumatic osteomyelitis can occur at any time after surgical treatment although the majority of recurrences are seen within 2 years.
