REAmER / IRRIgAtoR / ASPIRAtoR (RIA)

REAmER / IRRIgAtoR /
ASPIRAtoR (RIA)
For intramedullary reaming
and bone harvesting
SuRgIcAL tEcHnIquE
table of contents
Introduction
Reamer / Irrigator / Aspirator (RIA)
2
Indications4
Surgical Technique
Preparation5
Assembly9
Reaming18
Product Information
Bone Harvesting 20
Reamer Head Exchange
22
Disassembly 24
Instruments25
Power Equipment
31
Set List
32
Image intensifier control
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies
Reamer / Irrigator / Aspirator (RIA)
Reaming with reduced risk of systemic complication
• Reduces intramedullary pressure
• Reduces potential for fat embolization
• Reduces heat generated
• Removal of infected tissue
•Time-saving, single-pass procedure
• Easier handling
• Sharp reamer heads for optimized cutting
Reamer head
Tube assembly
Fast, efficient reaming
Flow of irrigating fluid
Bone marrow, morselized bone
Autograft harvesting
•Familiar technique
Irrigation fluid constantly
cools reamer head and
emulsifies marrow for
easy evacuation
Sharp edges for
efficient cutting
2 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Removal of marrow and
bone through aspiration holes
creates negative
intramedullary pressure
Deep flutes to
minimize clogging
Reamer / Irrigator / Aspirator (RIA)
Locking clip
Drive shaft
Drive shaft seal
Irrigation fluid gravity-fed into
cannulation of drive shaft
Aspiration
of bone marrow
and finely
morselized bone
Mesh sized to capture
morselized bone
and bone marrow
Graft filter 100 cc capacity
Aspiration tube
connected to suction canister
Vacuum source creates suction
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 3
Indications
The DePuy Synthes RIA System is intended for use in adults
and adolescents (12-21 years)
•To clear the medullary canal of bone marrow and debris
•To effectively size the medullary canal for the acceptance
of an intramedullary implant or prosthesis
•To harvest finely morselized autogenous bone and bone
marrow for any surgical procedures requiring bone graft
to facilitate fusion and/or fill bone defects
•To remove infected and necrotic bone and tissue from the
medullary canal in the treatment of osteomyelitis
4 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Preparation
1
Select appropriate length of tube assembly
Instruments
314.745SRIA Tube Assembly, minimum 360 mm
length, sterile
314.746SRIA Tube Assembly, minimum 520 mm
length, sterile
Select the appropriate length RIA tube assembly based on
the length of the canal.
Length of the canalTube assembly
Less than 350 mm
360 mm
Greater than 350 mm
520 mm
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 5
Preparation
2
Confirm reaming diameter
Instrument
351.717
Depth Gauge
To estimate the canal diameter, position the image intensifier
for an AP view of the limb at the level of the isthmus. Hold
the radiographic depth gauge perpendicular to the limb and
overlay the diameter tabs over the isthmus. Read the diameter
on the tab that fills the canal. Repeat with an LM view.
a. For reaming only, choose the implant diameter. Select a
reamer head 1.0 mm to 1.5 mm larger than the chosen
implant diameter.
b. For bone harvesting, select a reamer head 1.0 mm to
1.5 mm larger than the canal diameter at the isthmus.
Note: Measure in both AP and LM view.
Caution: The distance of the depth gauge from the bone
and the position of the receiver affect the diameter
measurement.
Always place the depth gauge on the side of the limb
closest to the receiver. Estimate the width as follows:
Distance between depth gauge and bone
a. 25 mm = 1 mm larger reading
b. 50 mm = 2 mm larger reading
c. 100 mm = 3 mm larger reading
6 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Preparation
3
Access canal and place reaming rod
Instruments
351.706S
or
351.707S
2.5 mm Reaming Rod with ball tip, 950 mm
2.5 mm Reaming Rod with ball tip and
extension, 950 mm
393.10Universal Chuck with T-Handle
Gain access to the intramedullary canal using standard opening
procedures and instrumentation for the chosen implant or
entry point. Reduce the fracture, if present.
Attach the universal chuck with T-handle to the reaming rod.
Insert the reaming rod into the canal to the physeal scar.
Verify its position with the image intensifier.
Note: Ensure the reaming rod is centered in the canal in
both AP and LM views.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 7
Preparation
4
Confirm nail length (for reaming only)
Instruments
351.717
Depth Gauge
351.719
Depth Gauge Extension Tube
Assemble the extension tube to the depth gauge.
Place the depth gauge assembly over the reaming rod.
Note: The tip of the depth gauge assembly should be
positioned at the desired location of the implant end.
Caution: Use the depth gauge extension tube only with
the 950 mm reaming rod.
Determine the length of the canal. Choose implant length
accordingly.
Note: Consider dynamization when choosing implant
length.
8 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Assembly
1
Attach reamer head
Instruments
314.745S
RIA Tube Assembly, minimum
360 mm length, sterile
314.746S
RIA Tube Assembly, minimum
520 mm length, sterile
352.250S -
352.259S
Reamer Heads, for RIA
12.0 mm-16.5 mm, sterile
352.261S - 352.265S
Reamer Heads, for RIA
17.0 mm-19.0 mm, sterile
Select the appropriate reamer head. Insert it into the
tube assembly.
Caution: Reamer heads are sharp. Use the provided tip
protector when attaching the reamer head to the tube
assembly.
Note: The reamer head is attached correctly when it
can spin freely and is retained by the tube assembly.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 9
Assembly
2
Attach drive shaft to tube assembly and reamer head
Instruments
314.742
Drive Shaft, minimum 360 mm length
314.743
Drive Shaft, minimum 520 mm length
Select the appropriate length drive shaft. Guide the tip
of the drive shaft through the RIA tube assembly.
Mate the hexagonal end of the RIA drive shaft with the
hexagonal recess in the reamer head.
Note: Visually check mating through the aspiration
holes.
Caution: Improper assembly can result in product
breakage, which may lead to surgical delay, bone
damage, and/or adverse tissue damage.
11 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Assembly
Note: The drive shaft is properly attached when the
hex flats are not visible. The helix is also visible when
properly attached.
Caution: Improper assembly can result in product
breakage, which may lead to surgical delay, bone
damage, and/or adverse tissue damage.
Note: The drive shaft hex is properly engaged in the
reamer head when the retaining groove is hidden.
Caution: Improper assembly can result in product
breakage, which may lead to surgical delay, bone
damage, and/or adverse tissue damage.
Retaining
groove
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 11
Assembly
2
Attach drive shaft to tube assembly and reamer
head continued
Push the outer sleeve of the RIA drive shaft forward to
engage the body of the RIA tube assembly.
Caution: Improper assembly can result in product
breakage, which may lead to surgical delay, bone
damage, and/or adverse tissue damage.
Note: The drive shaft is properly attached when the tan
plastic coupling shaft is no longer visible.
Caution: Improper assembly of the drive shaft can
result in product breakage, which may lead to surgical
delay, bone damage, and/or adverse tissue damage.
11 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Assembly
3
Attach locking clip
Instrument
352.260S
Locking Clip, for RIA, sterile
Slide the locking clip onto the assembled RIA drive shaft and
tube assembly.
Note: The small ridge on the inner surface of the
locking clip matches the groove between the drive shaft
and the tube a
­ ssembly.
Rotate the locking clip until the circular notches on the
locking clip align with the corresponding buttons on the
tube ­assembly.
Button on tube assembly
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 11
Assembly
4
Attach drive shaft seal
Instrument
351.718S
Drive Shaft Seal, for RIA, sterile
Attach the drive shaft seal to the proximal end of the
drive shaft.
Note: The drive shaft seal is important to retain
irrigation fluid in the cannulation of the drive shaft.
11 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Drive shaft seal
Assembly
5
Attach drive unit to large quick coupling
Instruments
530.605
Battery Reamer/Drill
530.760Large Quick Coupling, for Battery Power Line
Select a cannulated drive unit that will deliver 3.5 Nm to
4.5 Nm of torque and 700 rpm to 900 rpm (standard drill
speed). Use the cannulated quick coupling to attach the
drive shaft to the drive unit.
Caution: Do not use a reduction drive. Drills with a
torque greater than 6 Nm must not be used. Power
equipment designed for reaming must not be used.
Alternative with Jacobs chuck with key
Alternative instrument
530.730
Jacobs Chuck with key
Use the Jacobs chuck to attach the drive shaft to the drive unit.
Note: Insert the key into one hole of the chuck and
tighten. Move the key to all subsequent holes on the
chuck and tighten again.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 11
Assembly
6
Connect irrigation
Additional materials
1-2 liter container of irrigation fluid (eg, isotonic 0.9% NaCl)
Irrigation tubing set (“TURP,” cysto-bladder, cystoscopy)
Suspend a 1 or 2 liter container of irrigation fluid approximately
one meter above the level of the RIA assembly.
Attach spike end of tubing set to the irrigation container.
Note: The clamp on the irrigation tubing set should be
closed until reaming begins.
Connect the opposite end of the irrigation tube to the irrigation
port on the tube assembly.
Note: The irrigation port is the smaller of the two ports
and is indicated by an “I”.
11 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Assembly
7
Connect aspiration
Additional materials
Aspiration/suction tubing (minimum diameter = 1⁄4“ or 6 mm)
2 -5 liter suction canister
Vacuum source
Connect the aspiration tube to the aspiration port on the
tube assembly.
Note: The aspiration port is the larger of the two ports
and is indicated by an “A”.
Alternative for bone harvesting
Instrument
352.229SGraft Filter for RIA, sterile
Connect the graft filter to the aspiration port on the
tube assembly.
Connect the distal end of the graft filter to the aspiration tube.
Note: Before use, ensure filter cap is tightened.
Connect the other end of the aspiration tube to the suction
canister. Connect the suction canister directly to the
vacuum source.
Note: Connect the aspiration tube directly to the
suction canister to avoid a reduction in suction. Never
connect several suction canisters in series.
Start the vacuum source, if necessary.
Note: Adjust to maximum level.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 11
Reaming
1
Introduce RIA assembly into medullary canal
Guide the reamer head over the reaming rod. Open the
irrigation clamp to start liquid flow and ensure vacuum
is operational.
Note: Prior to insertion into patient’s limb, visually
verify flow of irrigation fluid at the tip of the reamer
head.
Advance the RIA assembly over the reaming rod until the
­aspiration holes are fully immersed into the bone. Check
­position on the image intensifier. A flow of blood and bone
marrow becomes visible in the aspiration tube.
Aspiration
holes
Note: Flow of aspiration begins when aspiration holes
are fully immersed in the bone.
Caution: Never ream when there is no irrigation/
aspiration. The irrigation/aspiration cools the reamer
heads and removes bone marrow and morselized bone
from the medullary canal. Liquid flow is crucial for
proper system performance.
11 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Reaming
2
Ream
Begin reaming, using a gradual advance/retract technique.
Slowly advance 20 –30 mm and then retract 50-80 mm
allowing the irrigation fluid to flow in front of the reamer
head. Advance the assembly until resistance is felt, then repeat.
Note: An insufficient irrigation volume may lead to
clogging. To prevent clogging, avoid rapid advancement
of the assembly.
Caution: Periodically check that the reaming aspirate is
flowing through the tube and into the suction canister.
Stop reaming if there is no flow.
After the reamer head reaches the desired depth, withdraw
the RIA assembly while maintaining rotation of the drill.
Note: Reverse the drill if advancement of the reamer
becomes difficult.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 11
Bone Harvesting
Note: When deciding to harvest autogenous graft, the
patient’s history, bone quality, physiological condition
and compliance must be taken into account.
1
Turn off irrigation and aspiration
Instrument
352.229SGraft Filter, for RIA, sterile
Stop irrigation after withdrawing the RIA assembly from
the canal. Turn off suction, or clamp the suction tubing.
Disconnect the filter canister from the lid and move it to
the back table.
2
Prepare graft
Hold the graft filter vertically. Compress the bone graft by
gently pushing down on the plunger. Estimate the volume
of bone graft with the scale on the outer canister.
22 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Bone Harvesting
3
Remove graft from filter
With the plunger inserted, invert the filter. Remove the inner
filter from the canister.
Caution: When handling, do not hold the opening
downward as there is a risk of dropping the graft
material.
Hold the inner filter over an appropriate container.
Position the inner filter vertically. Push the bone graft out
of the filter with the plunger.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 22
Reamer Head Exchange
1
Disengage drive shaft
Intraoperative RIA reamer head exchange is determined
by surgeon preference.
Place reamer head tip protector over reamer head and
disengage drive shaft. The tip protector is provided with
each RIA reamer head.
Caution: Reamer heads are sharp.
finger
Align reamer head in aspiration hole. The reamer head is
correctly positioned when one reamer head finger is visible
in the aspiration hole.
finger
Correct alignment
Incorrect alignment
22 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Reamer Head Exchange
2
Remove reamer head
Insert a 3.5 mm or 4.0 mm hex screwdriver into the aspiration
hole at a 30° – 45° angle to collapse the reamer head finger.
Rotate screwdriver away from reamer head to release head.
Replace with sterile reamer head.
Note: Dispose of reamer head.
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 22
Disassembly
1
Remove drive shaft
Remove and dispose of the irrigation/aspiration tubing and
locking clip. Push the outer sleeve of the drive shaft toward
the body of the RIA tube assembly.
Keep the outer sleeve in a forward position while withdrawing
the drive shaft from the body of the tube assembly.
Remove the drive shaft from the RIA tube assembly.
Note: Dispose of the tube assembly and reamer head.
­Remove and dispose of the drive shaft seal.
22 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
SIngLE-uSE InStRumEntS
Reamer Heads
• conical tip helps centralize reamer
• Deep flutes minimize clogging
• Sharp edges for cutting efficiency
• Diameters: 12 mm -19 mm in 0.5 mm increments
• Stainless steel
• Sterile packed
• Attaches to RIA tube assemblies
Diameter
(mm)
Diameter
(mm)
352.250S
12.0
352.258S
16.0
352.251S
12.5
352.259S
16.5
352.252S
13.0
352.261S
17.0
352.253S
13.5
352.262S
17.5
352.254S
14.0
352.263S
18.0
352.255S
14.5
352.264S
18.5
352.256S
15.0
352.265S
19.0
352.257S
15.5
RIA tube Assemblies
• two lengths available (attach to corresponding drive shafts)
• Sterile packed
Length (mm)
314.745S
360
314.746S
520
2.5 mm Reaming Rods with ball tip
Length (mm)
351.706S
950
351.707S
950, with extension
351.708S
1150
Reamer / Irrigator / Aspirator (RIA)
Surgical Technique
DePuy Synthes Companies
25
Single-use Instruments
351.718S
Drive Shaft Seal, for RIA (2/pkg.)
• Elastomeric seal
• minimizes flow of irrigation fluid into drive unit
• Sterile packed
352.229S
graft filter, for RIA
• collects finely morselized bone chips and marrow
• capacity: 100 cc
• graduations for estimating volume
• Plunger for easy removal of graft
• Sterile packed
352.260S
Locking clip, for RIA
• Secures attachment between drive shaft and tube assembly
• Sterile packed
26
DePuy Synthes Companies
Reamer / Irrigator / Aspirator (RIA)
Surgical Technique
ADDItIonAL mAtERIALS
Irrigation fluid Bag
• 1 -2 liters for reaming
• 3 liters minimum for harvesting
Suction canister
• 2 liters minimum for reaming
• 3 liters minimum for harvesting
Irrigation tubing
• clip to control liquid flow
• Spike to connect irrigation fluid bag
(“tuRP,” cysto-bladder, cystoscopy)
Aspiration/Suction tubing
• minimum diameter: 1⁄4”, or 6 mm, allowing tight seal
around port
Vacuum Source
• Wall suction or portable suction
Reamer / Irrigator / Aspirator (RIA)
Surgical Technique
DePuy Synthes Companies
27
Instruments
314.742
Drive Shaft, minimum 360 mm length
314.743
Drive Shaft, minimum 520 mm length
351.05Tissue Protector
351.717
Depth Gauge
351.719
Depth Gauge Extension Tube
393.10Universal Chuck with T-Handle
22 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Optional Instruments
03.010.03612.0 mm Cannulated Drill Bit,
large quick coupling, 190 mm
03.010.040
12.0 mm Cannulated Awl
03.010.115
3.2 mm Guide Wire, 290 mm
351.02
Small Awl, 210 mm length
351.782
Holding Forceps
351.92
351.93
351.94
Hand Reamers, 450 mm length
6.0 mm
7.0 mm
8.0 mm
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 22
Optional Instruments
355.006Medullary Tube
Note: Single sterilization only.
Do not use with 3.0 mm Reaming Rod
with offset ball tip (351.71).
357.4036.0 mm/10.0 mm Stepped Cannulated
Drill Bit, large quick coupling, 435 mm
33 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Power Equipment
530.605
Battery Reamer/Drill
530.730
Jacobs Chuck with Key, for Battery
Power Line
530.760Large Quick Coupling, for Battery
Power Line
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 33
Reamer / Irrigator / Aspirator Instrument Set
(105.309)
Graphic Case
690.308
Reamer / Irrigator / Aspirator, Instrument
Set Graphic Case
Instruments
314.742Drive Shaft, minimum 360 mm length, for
use with Reamer / Irrigator / Aspirator (RIA)
314.743Drive Shaft, minimum 520 mm length, for
use with Reamer / Irrigator / Aspirator (RIA),
2 ea.
351.05Tissue Protector
351.717
Depth Gauge
351.719
Depth Gauge Extension Tube
393.10Universal Chuck with T-Handle
For detailed cleaning and sterilization instructions, please refer to:
www.synthes.com/cleaning-sterilization
In Canada, the cleaning and sterilization instructions will be provided with
the Loaner shipments.
33 DePuy Synthes Companies Reamer / Irrigator / Aspirator (RIA) Surgical Technique
Also Available
Single-use Items
314.745SReamer / Irrigator / Aspirator Tube
Assembly, minimum 360 mm length,
sterile, for use with RIA drive shaft
(314.742)
314.746SReamer / Irrigator / Aspirator Tube
Assembly, minimum 520 mm length,
sterile, for use with RIA drive shaft
(314.743)
Instruments
03.010.03612.0 mm Cannulated Drill Bit, large quick
coupling, 190 mm
03.010.040
12.0 mm Cannulated Awl
03.010.115
3.2 mm Guide Wire, 290 mm
351.02
Small Awl, 210 mm length
351.15Flexible Shaft Handle, quick coupling,
cannulated
351.782
Holding Forceps
351.92
6.0 mm Hand Reamer, 450 mm length
351.707S2.5 mm Reaming Rod with ball tip and
extension, 950 mm, sterile
351.93
7.0 mm Hand Reamer, 450 mm length
351.94
8.0 mm Hand Reamer, 450 mm length
351.708S2.5 mm Reaming Rod with ball tip,
1150 mm, sterile
352.040
5.0 mm Flexible Shaft, 470 mm
352.050
7.0 mm Reduction Head, straight
351.718SDrive Shaft Seal, for
Reamer / Irrigator / Aspirator, sterile
(2/pkg.)
352.055
7.0 mm Reduction Head, angled
351.706S2.5 mm Reaming Rod with ball tip,
950 mm, sterile
352.229SGraft Filter, for
Reamer / Irrigator / Aspirator, sterile
352.260SLocking Clip, for
Reamer / Irrigator / Aspirator, sterile
355.006Medullary Tube
357.4036.0 mm/10.0 mm Stepped Cannulated
Drill Bit, large quick coupling, 435 mm
360.243Handle, for 12.0 mm Tapered Intramedullary
Reduction Tool
360.244Shaft, for 12.0 mm Tapered Intramedullary
Reduction Tool
Reamer Heads, for Reamer / Irrigator / Aspirator, sterile
Diameter Diameter
(mm)(mm)
Power Equipment
511.73
Jacobs Chuck with Key
352.250S 12.0
352.258S16.0
511.761
Large Quick Coupling
352.251S 12.5
352.259S16.5
530.100
Power Drive
530.605
Battery Reamer/Drill
352.252S 13.0
352.261S17.0
352.253S 13.5
352.262S17.5
352.254S 14.0
352.263S18.0
352.255S 14.5
352.264S18.5
352.256S 15.0
352.265S19.0
352.257S15.5
530.730Jacobs Chuck with key, for Battery
Power Line
530.760
Large Quick Coupling, for Battery
Power Line
Recommended Additional Sets
115.545
Accessory Instrument Set for IM Nail Insertion
150.060Flexible Reamer Set for IM Nails
150.16Compact Air Drive II Set
150.119
Battery Power Line Set
105.957
Power Drive Set
105.955
Small Battery Drive Set
Reamer / Irrigator / Aspirator (RIA) Surgical Technique DePuy Synthes Companies 33
CAUTION: Federal Law Restricts These Devices To Sale By Or On The Order Of A Physician.
Some devices listed in this technique guide may not have been licensed in accordance with
Canadian law and may not be for sale in Canada. Please contact your sales consultant for
items approved for sale in Canada.
Manufactured by (United States):
Legal manufacturer (Canada):
Synthes USA Products, LLC
1302 Wrights Lane East
West chester, PA 19380
telephone: (610) 719-5000
to order: (800) 523-0322
fax: (610) 251-9056
Synthes (Canada) Ltd.
2566 meadowpine Boulevard
mississauga, ontario L5n 6P9
telephone: (905) 567-0440
to order: (800) 668-1119
fax: (905) 567-3185
www.depuysynthes.com
© DePuy Synthes 2015. All rights reserved.
DSuS/tRm/0615/0627 6/15 DV