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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 17 mars 2019
Doi : 10.1016/j.otsr.2018.12.011
Received : 19 February 2018 ;  accepted : 11 December 2018
Can the Reamer/Irrigator/Aspirator System replace anterior iliac crest grafting when treating long bone nonunion?

Marie Le Baron a, , Jean-Philippe Vivona b, Pascal Maman a, Richard Volpi a, Xavier Flecher a
a Institut du mouvement et de l’appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France 
b Polyclinique du Parc-Rambot – Provençale, 67, cours Gambetta, 13100 Aix-en-Provence, France 

Corresponding author.

Autologous bone graft is the gold standard for filling bone defects associated with diaphyseal nonunions. It is typically harvested from the anterior iliac crest (AIC) despite the high complication rate. The Reamer/Irrigator/Aspirator System (RIA) was developed to recover the reaming aspirate and use it as autograft. Initially described for harvesting bone from the femur, the bone volume available is similar to the AIC site; however, its use directly at nonunion sites has been studied very little.


Compared to AIC harvesting, RIA at a non-union site will result in (1) sufficient bone volume, (2) similar time to union and union rate, (3) lower morbidity.


Two groups of patients received an autograft for aseptic nonunion of the tibia or femur for a bone defect up to 2cm: the RIA group (n =30) was followed prospectively and received an autograft by RIA while the AIC group (n =29) was reviewed retrospectively and received an autograft by AIC. We compared the time to union and union rate, operative time, intake of analgesics, duration of hospital stay and complication rate between groups. The RIA provided sufficient bone, 60cm3 on average in a reliable manner. The union rate was similar between groups: 90% (RIA) and 89.7% (CIA) (p =0.965), while the time to union was shorter in the RIA group (8.63±1.47months vs. 10.08±1.7 months) (p =0.006). The operative time (p <0.0001), analgesic intake (p =0.013), length of stay (p <0.0001) and immediate complication rate (p =0.0195) were higher in the AIC group.


For the treatment of aseptic long bone nonunion, autograft harvested by the RIA from the nonunion site results in similar union rate and time to union as AIC grafts without additional complications.

Level of evidence

IV, comparative retrospective study.

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Keywords : Nonunion, Bone grafting, Tibia fracture, Femur fracture

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