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‘Modest’ reduction in embolic debris seen during reaming, nail insertion with RIA
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NEW YORK — Researchers of a multicenter, prospective randomized study presented here that compared use of a standard reamer to use of a reamer irrigator-aspirator device during intramedullary nailing of isolated, closed femoral shaft fractures found a 1-point reduction in the total emboli score during reaming and nail insertion in favor of the device.
“We feel there is a modest reduction in embolic debris during the reaming and nail insertion segments of the operative procedure with the use of the reamer irrigator-aspirator,” Emil H. Schemitsch, MD, said at the International Society for Fracture Repair Meeting. “We were unable to correlate the changes in embolic events with any change in physiologic parameters. The significance of this reduction in embolic debris is uncertain.”
Schemitsch and colleagues studied 22 patients who received a statically locked reamed intramedullary nail and were randomized to treatment using a standard reamer or a reamer irrigator-aspirator (RIA) device. Patients were followed up at 2 weeks, 6 weeks, 3 months, 6 months and 12 months. The researchers used a continuous transesophageal echocardiogram to determine the embolic debris in patients preoperatively and postoperatively and during the reduction, guide-wire passage, reaming and nail insertion. Four observers analyzed the recordings.
The investigators found no significant differences between the groups in terms of gender, age, body mass index or injury severity score. Although researchers observed no significant differences in the total emboli score between the groups preoperatively or during reduction or guide-wire passage, there was a 1-point reduction in the score during reaming and nailing in favor of the RIA device. However, investigators saw no significant difference in this score postoperatively.
They were also unable to correlate the reduction in embolic score with any improvement in physiologic parameters studied including mean arterial pressure, end tidal carbon dioxide, oxygen saturation, pH, paO2 and paCO2.
There were three minor complications in the standard reamer group and two minor complications in the RIA cohort, Schemitsch said. There were two major complications in the standard reamer group, including two patients who had prolonged intubation. In the RIA group, one patient sustained an intraoperative femoral neck fracture that required fixation and one patient had a pulmonary embolism at 8 days postoperatively. – by Gina Brockenbrough, MA
Reference:
Schemitsch EH. Abstract #4. Presented at: International Society for Fracture Repair Meeting; May 14-17, 2014; New York.
Disclosure: The study was funded by an Orthopaedic Trauma Association research grant and the RIA devices were supplied by Synthes.