Novel Technique for Extracting Metallic Debris from a Broken Reamer - Irrigator - Aspirator-2 Head within the Intramedullary Canal

Sep 29, 2026

A reamer-irrigator-aspirator (RIA) system is described as a safe method to harvest intramedullary autograft and tissue for culture, but mechanical complications can occur, including reamer-head dissociation with retained metallic debris. This article reports a technically focused case in which a laparoscopic suction device is used to remove loose intramedullary debris after fragmentation. The authors conclude that the technique is safe, reliable, and effective for complete debris removal in repeated clinical use.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Abstract

Introduction

Surgical Technique and Case

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 36-39 Novel Technique for Extracting Metallic Debris from a Broken ReamerIrrigator-Aspirator-2 Head within the Intramedullary Canal Devin QJohn1, DavidA Patch2, Walt R Smith2, Doriann M Alcaide2, Jonathan H Quade2 Learning Point of the Article: Alaparoscopic suction instrument can extract debris from the intramedullary canal of long bones. Abstract Introduction: Thereamer-irrigator-aspirator (RIA)is safe and effective for harvesting intramedullary autograft and tissue for culture. However, mechanical complications such as reamerhead dissociationwith retained intramedullary debris havebeenpreviously reported. Case Report: Techniques to remove the metallic debris have been described, but are technically challenging and inefficient. The authors provide a novel techniqueto aid in theremoval of loose debris using alaparoscopic suction device. Conclusion: We have utilized this instrument on multiple occasions, and it has demonstrated itself tobe safe, reliable, and effective at removing all debris. Keywords: Reamerirrigator aspirator, intramedullary canal, complications, debris. Introduction The reamer-irrigator-aspirator (RIA) system (DePuy Synthes®, West Chester, PA) (RIA-2) is a safe and effective device for harvesting bone autograft and culture tissue from the long bones of the lower extremity [1, 2, 3]. The autograft acquired using RIA has been shown to be superior to iliac crest bone grafting regarding pain and volume of graft harvested and equivalent with union rates, infection, and revision procedures [4]. However, like all surgical procedures, RIA has patient-related complications that surgeons should consider. These include iatrogenic femur fractures [5], post-operative pain at the entry site [6], increased blood loss [3], as well as mechanical complications such as breakage of the drive shaft tip [7] or reamer head dissociation [8, 9]. These mechanical issues can be managed using the ball-tip guidewire to extract the reamerhead [7, 8, 9]; however, retained metal debris posesan additional challenge. Chlorosetal. recently reported using curettes, graspers, and a nail extraction hook under fluoroscopy to successfully remove retained debris [10]. The authors are reporting a novel technique that the treating orthopedic trauma surgeon can use to successfully remove intramedullary debris. Surgical Technique and Case Illustrative case A 40-year-old generally healthy Hispanic male with a history ofa complex right femur fracture managed at an outside facilitywith intramedullary nailing, subsequent corrective osteotomy, and hardware removal presented to our academic institution for |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6446](https://doi.org/10.13107/jocr.2025.v15.i12.6446) | Author’s Photo Gallery | | | | | | --- | --- | --- | --- | --- | --- | | | | | | | | | |
1Department of Orthopaedic Surgery, HCA Florida JFK Hospital, Atlantis, FL, USA,
2Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Address of Correspondence:
Dr. Jonathan H Quade,
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. [E-mail:](E-mail: jhquade@uabmc.edu)[ jhquade@uabmc.edu](E-mail: jhquade@uabmc.edu) | | | | | | Submitted: 08/09/2025; Review: 25/10/2025; Accepted: November 2025; Published: December 2025 | | | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6446](https://doi.org/10.13107/jocr.2025.v15.i12.6446)
© The Author(s). 2025 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)), which permits unrestricted use, distribution, and non-commercial reproductio

FAQs

What complication does the article focus on after using the RIA system?

It focuses on mechanical complications such as reamer-head dissociation that leaves retained intramedullary metallic debris.

What technique is proposed to remove the retained metallic debris?

The authors use a laparoscopic suction device to aid in removing loose intramedullary debris.

How effective and safe is the laparoscopic suction approach according to the conclusion?

The technique is reported as safe, reliable, and effective at removing all debris, based on multiple author uses.

Sep 29, 2026

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