Authors: C.G. Zalavras*, A. Singh, M.J. Patzakis
Title: A Novel Method for Debridement of the Medullary Canal in Osteomyelitis of the Tibia and Femur
Addresses: Department of Orthopaedics, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N State St, GNH 3900, Los Angeles, CA 90033
Purpose: Intramedullary infection of the tibia and femur is a challenging problem and management usually includes removal of the infected hardware and reaming of the medullary canal. The purpose of this study is to describe a new technique for canal debridement and evaluate its efficacy in the treatment of posttraumatic osteomyelitis of the tibia and femur.
Methods: This is a retrospective study of 12 patients (11 male and 1 female, mean age 42 years) with posttraumatic osteomyelitis of the tibia (n = 9) or femur (n = 3). The infection was present for a median time of 12 months (2 weeks to 8 years) before treatment at our institution. Surgical treatment consisted of debridement, removal of existing implants (11 intramedullary nails and 1 external fixator), and reaming of the medullary canal with the RIA (Reamer Irrigator Aspirator) device. All procedures were performed by a single surgeon with a standardized technique. Reaming of the canal was performed with one pass of the RIA, using a reamer head of predetermined diameter (median diameter was 12 mm for the tibia and 13.5 mm for the femur) based on the diameter of the canal. Following reaming, the RIA was used for irrigation of the medullary canal with 10 liters of fluid. Antibiotic therapy with culture-specific antibiotics was administered for 6 weeks.
Results: Use of the RIA device was not associated with any intraoperative problems or difficulties. Ten patients were followed-up for a mean time of 9 months (6 to 13 months).There was no recurrence of osteomyelitis. Complications included partial loss of a flap and refracture of a tibia following an auto versus pedestrian accident.
Discussion: The RIA device allows for reaming under simultaneous irrigation and aspiration, which may minimize the residual amount of infected tissue in the medullary canal. The disposable reamer head is always sharp, in contrast to standard reamers, which may reduce the thermal effects of reaming on the adjacent bone. In addition, the RIA allows delivery of fluid throughout the length of the medullary canal, thus facilitating irrigation.
The RIA device is useful alternative for debridement of intramedullary infections of the tibia and femur.