Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigatoraspirator
(RIA) autogenous bone grafting (ABG) of high-grade open tibia fracture nonunions stabilized via multiplanar
external fixation.
Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with
multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center
between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were
included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery.
Complications and all-cause reoperation were recorded as secondary endpoints.
Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested
from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months,
all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft
fracture four months following RIA that required intramedullary fixation. The average time to union was
6.0 ± 6.3 months. Twelve patients (80%) went on to union within six months and 13 (86.7%) within one year. Five
patients experienced a total of six post-operative complications including three deep infections, one refracture through
the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting
procedure secondary to persistent nonunion despite initial RIA.
Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial
fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.