In intramedullary nailing of femoral shaft fractures, the 'reamer-irrigator-aspirator' (RIA) system is used to reduce which SPECIFIC complication compared to conventional reaming?

• A Thermal necrosis of the endosteum
• B Rotational malalignment
• C Nail insertion site pain
• D Fat embolism syndrome due to intramedullary fat/marrow embolism ✓

Explanation

Conventional reaming for IM nailing generates high intramedullary pressure, forcing fat, marrow contents, and bone fragments into the venous sinusoids — causing pulmonary fat embolism. The RIA system simultaneously reams, irrigates (reducing thermal necrosis and pressure), and aspirates (removing debris before it enters the circulation), substantially reducing intramedullary pressure and embolic burden. Additionally, the aspirate can be used as autogenous graft. RIA does not directly address rotational control or insertion-site pain.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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