{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T04:33:19Z","timestamp":1769574799690,"version":"3.49.0"},"reference-count":42,"publisher":"Open Medical Publishing","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures.<\/jats:p> <jats:p>Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union.<\/jats:p> <jats:p>The Reamer-Irrigator-Aspirator (RIA) System\u00ae was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature.<\/jats:p> <jats:p>In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed.<\/jats:p> <jats:p>Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.<\/jats:p>","DOI":"10.52965\/001c.37889","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T01:57:55Z","timestamp":1664848675000},"source":"Crossref","is-referenced-by-count":6,"title":["The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review."],"prefix":"10.52965","volume":"14","author":[{"given":"Marco","family":"Landrino","sequence":"first","affiliation":[{"name":"University of East Piedmont, Novara (Italy)","department":["Department of Health Sciences"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo Luigi","family":"Alberio","sequence":"additional","affiliation":[{"name":"Hospital \"Maggiore della Carit\u00e0\", Novara (Italy)","department":["Orthopaedic and Traumatology"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Clemente","sequence":"additional","affiliation":[{"name":"University of East Piedmont, Novara (Italy)","department":["Department of Health Sciences"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico Alberto","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia (Italy); IRCCS Hospital San Matteo, Pavia (Italy)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"30777","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"issue":"8","key":"ref1","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/s1063-4584(03)00089-x","article-title":"Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee","volume":"11","author":"F Salaffi","year":"2003","journal-title":"Osteoarthritis and Cartilage","ISSN":"https:\/\/id.crossref.org\/issn\/1063-4584","issn-type":"print"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.tcr.2017.05.011","article-title":"Stuffing the nail: A simple technique for the extraction of a broken femoral nail","volume":"9","author":"Jane Lovell","year":"2017","journal-title":"Trauma Case Reports","ISSN":"https:\/\/id.crossref.org\/issn\/2352-6440","issn-type":"print"},{"issue":"1","key":"ref3","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/1477-7525-9-75","article-title":"Validation of a proposed WOMAC short form for patients with hip osteoarthritis","volume":"9","author":"Amaia Bilbao","year":"2011","journal-title":"Health and Quality of Life Outcomes","ISSN":"https:\/\/id.crossref.org\/issn\/1477-7525","issn-type":"print"},{"issue":"6","key":"ref4","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1007\/s00402-019-03131-9","article-title":"Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures","volume":"139","author":"Dietmar Krappinger","year":"2019","journal-title":"Archives of Orthopaedic and Trauma Surgery","ISSN":"https:\/\/id.crossref.org\/issn\/0936-8051","issn-type":"print"},{"issue":"1","key":"ref5","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799x-8-43","article-title":"Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort","volume":"8","author":"Martin F Hoffmann","year":"2013","journal-title":"Journal of Orthopaedic Surgery and Research","ISSN":"https:\/\/id.crossref.org\/issn\/1749-799X","issn-type":"print"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1016\/s0020-1383(15)30049-8","article-title":"Risk factors for long bone fracture non-union: A stratification approach based on the level of the existing scientific evidence","volume":"46","author":"Emmanuele Santolini","year":"2015","journal-title":"Injury","ISSN":"https:\/\/id.crossref.org\/issn\/0020-1383","issn-type":"print"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1016\/s0020-1383(07)80005-2","article-title":"Definition and classification of fracture non-unions","volume":"38","author":"Jan Paul M. 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