{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:04:32Z","timestamp":1792389872231,"version":"4.4.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Patient Saf Surg"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The Reamer\u2013Irrigator\u2013Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures. Currently, this system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. Antegrade femoral bone graft harvesting using the Reamer-Irrigator-Aspirator system is considered the standard technique. The aim of our study is to evaluate the efficacy (bone graft volume) and the complications (blood loss, postoperative pain, and incidence of iatrogenic fractures) of the Reamer\u2013Irrigator\u2013Aspirator system through the retrograde femoral route in a series of patients with post-traumatic bone defects or nonunions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A non-controlled single center retrospective observational cohort study was conducted in a level1 trauma center to evaluate all patients who were treated using the RIA system. Between November 2015 and May 2019, 24 patients (8 women and 16 men; mean age: 41\u00a0years [range 27\u201355\u00a0years]) with bone defects or nonunions underwent bone graft harvesting using the Reamer\u2013Irrigator\u2013Aspirator system through retrograde femoral route. Postoperative pain, complications, and bone graft volume were analyzed. Inclusion criteria was patients older than 18\u00a0years with a diagnosis of post-traumatic bone defect or associated tibial or femoral nonunion, with minimum 6-months follow, treated using the RIA. We hypothesized that the retrograde route of the RIA system is a safe and efficacious method for bone harvesting.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The average volume of collected graft was 45\u00a0cc (range 30\u201360\u00a0cc). In 83% of the cases, bone grafting was sufficient, while in 17% it was necessary to add iliac crest bone graft to completely fill the bone defect. A mean drop in postoperative hemoglobin of 4.1\u00a0g \/ dL (range 0.5\u20136.0\u00a0g \/ dL) was evidenced. In 4 cases (33%), a unit of packed red blood cells was required. Regarding postoperative pain, visual analogue scale after 3\u00a0months postoperatively was 1.6 in average. After 6\u00a0months, the value has decreased to 0.4. There were no perioperative or postoperative complications at 6-month follow-up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In this limited case series, large volumes of bone graft were harvested using the retrograde route of the RIA system and there were no intra-\/ postoperative complications observed at 6-month follow-up. Therefore this novel technique appears safe and efficacious.<\/jats:p>\n                <jats:p>However, it\u2019s important to highlight that future prospective controlled studies are necessary to validate the insights from this pilot study.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13037-021-00315-4","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T19:02:48Z","timestamp":1641582168000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Safety and efficacy of a novel retrograde route for femoral bone graft harvesting by Reamer-Irrigator-Aspirator: a pilot study on 24 patients"],"prefix":"10.1186","volume":"16","author":[{"given":"Fernando","family":"Bidolegui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e1n","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Irigoyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3572-5576","authenticated-orcid":false,"given":"Robinson Esteves","family":"Pires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,7]]},"reference":[{"issue":"7","key":"315_CR1","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1007\/s00264-010-1189-z","volume":"35","author":"G Cox","year":"2011","unstructured":"Cox G, Jones E, McGonagle D, Giannoudis PV. Reamer-irrigator-aspirator indications and clinical results: a systematic review. Int Orthop. 2011;35(7):951\u20136. https:\/\/doi.org\/10.1007\/s00264-010-1189-z.","journal-title":"Int Orthop"},{"issue":"11","key":"315_CR2","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.injury.2009.07.070","volume":"40","author":"PV Giannoudis","year":"2009","unstructured":"Giannoudis PV, Tzioupis C, Green J. Surgical techniques: how I do it? The Reamer\/Irrigator\/Aspirator (RIA) System. Injury. 2009;40(11):1231\u20136. https:\/\/doi.org\/10.1016\/j.injury.2009.07.070.","journal-title":"Injury"},{"issue":"3","key":"315_CR3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3928\/01477447-20080301-29","volume":"31","author":"JT Newman","year":"2008","unstructured":"Newman JT, Stahel PF, Smith WR, Resende GV, Hak DJ, Morgan SJ. A new minimally invasive technique for large volume bone graft harvest for treatment of fracture nonunions. Orthopedics. 2008;31(3):257\u201361.","journal-title":"Orthopedics"},{"issue":"1","key":"315_CR4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s00068-017-0821-7","volume":"45","author":"WJ Metsemakers","year":"2019","unstructured":"Metsemakers WJ, Claes G, Terryn PJ, Belmans A, Hoekstra H, Nijs S. Reamer\u2013Irrigator\u2013Aspirator bone graft harvesting for treatment of segmental bone loss: analysis of defect volume as independent risk factor for failure. Eur J Trauma Emerg Surg. 2019;45(1):21\u20139. https:\/\/doi.org\/10.1007\/s00068-017-0821-7.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"315_CR5","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1016\/j.injury.2017.04.025","volume":"48","author":"N Dehghan","year":"2017","unstructured":"Dehghan N, Schemitsch EH. Extended applications of the reamer-irrigator-aspirator (RIA) system. Injury. 2017;48(1):S47-51. https:\/\/doi.org\/10.1016\/j.injury.2017.04.025. 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Complications and risk management in the use of the reaming-irrigator-aspirator (RIA) system: RIA is a safe and reliable method in harvesting autologous bone graft. PLoS One. 2018;13(4): e0196051. https:\/\/doi.org\/10.1371\/journal.pone.0196051.","journal-title":"PLoS One"},{"issue":"4","key":"315_CR18","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/BOT.0000000000000811","volume":"31","author":"LS Marchand","year":"2017","unstructured":"Marchand LS, Rothberg DL, Kubiak EN, Higgins TF. Is this autograft worth it?: the blood loss and transfusion rates\nassociated with reamer irrigator aspirator bone graft harvest. J Orthop Trauma. 2017;31(4):205\u20139. https:\/\/doi.org\/10.1097\/BOT.0000000000000811.","journal-title":"J Orthop Trauma"}],"container-title":["Patient Safety in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13037-021-00315-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13037-021-00315-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13037-021-00315-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T19:16:39Z","timestamp":1641582999000},"score":1,"resource":{"primary":{"URL":"https:\/\/pssjournal.biomedcentral.com\/articles\/10.1186\/s13037-021-00315-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,7]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["315"],"URL":"https:\/\/doi.org\/10.1186\/s13037-021-00315-4","relation":{},"ISSN":["1754-9493"],"issn-type":[{"value":"1754-9493","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,7]]},"assertion":[{"value":"9 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained by the ethics committee of the main institution. The manuscript contains no individual personal data. No consent for publication was necessary.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that there are no monetary or other conflicts of interest related to the RIA product and the manufacturer of the device investigated in this study (DePuy-Synthes).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}