Infected femoral nail removal and debridement with Synthes Reamer Irrigator Aspirator (RIA)
Subscribe to get full access to this operation and the extensive Hip Surgery Atlas.
Professional Guidelines Included
Learn the Infected femoral nail removal and debridement with Synthes Reamer Irrigator Aspirator (RIA) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Infected femoral nail removal and debridement with Synthes Reamer Irrigator Aspirator (RIA) surgical procedure.
Fracture related infection (FRI) has a spectrum of presentations ranging from early and obvious infection after fracture fixation to delayed presentations with infected non-union of fractures. Its incidence is reported as being between 1-30% of fractures and is more common following open injuries. FRI has various potential aspects to its presentation and management, including bone infection, soft tissue injury, fractures in varying states of healing and metalwork with biofilm. There is currently a lack of high quality evidence to guide practice in this area and there have been a number of recent consensus papers and a BOAST guideline in an attempt to define best practice.
Diagnostic criteria considered to confirm FRI include a sinus, fistula or wound breakdown over bone or implant, purulent discharge or pus found during surgery, phenotypically indistinguishable pathogens from 2 deep samples or histopathological staining for bacteria or fungi. Criteria suggestive of FRI include clinical signs of local inflammation (pain, swelling, redness, temperature), radiological signs (lysis, implant loosening, sequestration, periosteal bone formation), elevated blood markers (WBC, CRP, ESR) or a pathogenic organism grown from a single deep tissue sample.
RIA is made by Synthes, as the name suggests it simultaneously reams, aspirates and irrigates the intramedullary canal as it is passed.
It can be used simply to harvest autologous bone graft for reconstruction cases however it also allows simultaneous reaming of infected material with irrigation as the reamer passes and collection of the reamings to remove and sample infected tissues in infected cases. RIA is not routinely used for primary nailing of fractures as there is an advantage to autografting the fracture site with reamings rather than removing them.
Author:Paul Fenton FRCS (Tr & Orth)
Institution: The Queen Elizabeth Hospital, Birmingham UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.