Effects of the second-generation reamer-irrigator-aspirator (RIA 2) on local microcirculation and systemic inflammation in a porcine polytrauma model

Objectives The effects of reamed nailing include microcirculatory changes and activation of the systemic inflammatory response. The next generation reamer-irrigator-aspirator (RIA 2, released 2019) includes a new design for improved handling, increased relative hole-size at the reamer head for improved irrigation and aspiration, and smaller diameter of the reamer head (starting at 10mm compared to 12mm in RIA 1). We evaluated different intramedullary reaming techniques in a standardized polytrauma model in pigs.

Methods Porcine Polytrauma model: standardized femoral shaft fracture, liver laceration, blunt thoracic trauma, and MAP-controlled hemorrhagic shock (1 hour). Groups: RIA 1 (2005 version), RIA 2 (2019 version), Conventional reaming (RFN), or No reaming (UFN). Retrograde femoral nailing. Timepoints: Reaming and one hour after reaming; Outcome measures: Systemic Interleukin 6 (IL-6), local microcirculation subcutaneous at fracture site, vital parameter, and blood gas analysis (BGA).

Results and Conclusion Group RIA 1 (n=6), Group RIA 2 (n=7), Group RFN(n=7), and Group UFN (n=7); No significant differences in the course of BGA, including lactate. RIA 2 is comparable in measures of vital parameter and BGA values with RIA 1 (p>0.1).

Group UFN and RFN: After one hours significant increase of central venous pressure (p =0.014, p =0.017 resp.) and significant increase of systemic IL-6 (p =0.027, p =0.029 resp.). Group RIA 1 and RIA 2: significant increase of local microcirculation up to 80 % (p < 0.001).

Conclusion RIA 2 is comparable with RIA 1 in its systemic inflammatory response and local effects on microcirculation. Conventional reaming and unreamed femoral nailing are associated with increased central venous pressure and systemic inflammation after one hour after reaming.

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Publication History

Article published online:
15 October 2020