Intramedullary Bone Graft Harvest Using Reamer-Irrigator-Aspirator System: A Case Series

Autogenous iliac crest bone grating has been the gold standard. Recently, intramedullary bone graft harvest using a reamer-irrigator-aspirator (RIA) had been gaining more interest among orthopedic surgeons. Twenty-four RIA bone graft harvesting procedures in 23 consecutive patients with nonunions were included. The mean age was 37.8 years. Rates of perioperative complications, secondary surgical procedures, and union were assessed for all patients. At mean 10.1 months follow-up, three donor site complications occurred (12.5%), including two fractures (8.3%). Eighteen patients (78%) progressed to radiographic union, three (13%) were lost for follow-up, and two (9%) failed to achieve union. Mean reamer size was 13.7 mm (mode, 14.0 mm), producing an average volume of 39.4 mL (range, 15-90 mL) bone graft. While RIA bone grafting results in predictably high rates of union, patients should be counseled extensively about fracture risk. Tibial RIA may be less optimal as a primary source of bone grafting. (Journal of Surgical Orthopaedic Advances 26(4):233-238, 2017).