Infected femoral nail removal and debridement with Synthes Reamer Irrigator Aspirator (RIA) surgical technique
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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.
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Question 1 of 15
All of the following are considered confirmatory of fracture related infection except which one ?CorrectIncorrect
Question 2 of 15
Which one of the following is least suggestive of probable fracture related infection?CorrectIncorrect
Question 3 of 15
According to the Willenegger and Roth classification ‘early’ infection is defined as occurring at which one of the following times?CorrectIncorrect
Question 4 of 15
According to the Cierny and Mader classification in a type C host which one of the following is true?CorrectIncorrect
Question 5 of 15
Which one of the following is not a recognised pattern of adult ostoemyelitis according to Cierny and Made?CorrectIncorrect
Question 6 of 15
Which one of the following radiological features is least suggestive of fracture related infection?CorrectIncorrect
Question 7 of 15
Regarding MRI in the investigation of fracture related infection which one of the following is true?CorrectIncorrect
Question 8 of 15
When removing locking bolts from an intramedullary nail following fracture related infection which one of the following is true?CorrectIncorrect
Question 9 of 15
When using the Reamer Irrigator Aspirator (RIA), which of the following is not used to choose the reamer head size?CorrectIncorrect
Question 10 of 15
All of the following are principles of deep tissue sampling of suspected bone infection except which one?CorrectIncorrect
Question 11 of 15
Which one of the following should be used for irrigation following bone debridement?CorrectIncorrect
Question 12 of 15
All of the following can be used to manage dead space in the bone following debridement except which one?CorrectIncorrect
Question 13 of 15
Osteoset T elutes antibiotics for approximately how long?CorrectIncorrect
Question 14 of 15
Soft tissue defects following bone debridement are optimally managed with which one of the following techniques?CorrectIncorrect
Question 15 of 15
Which one of the following is true in relation to the OVIVA trial?CorrectIncorrect