The reamer-irrigator-aspirator (RIA) system has been recently developed to decrease the incidence of osseous thermal necrosis and fat embolism associated with intramedullary reaming of long bones in trauma cases. This is achieved by continuous irrigation and suction. Recently, the use of RIA has been expanded to harvest bone graft and debride the medullary canal of long bones in cases of osteomyelitis and intramedullary tumors. Additionally, the collection system of this device has been utilized for its ability to capture bone graft and marrow aspirate. The purpose of this study is to report a comprehensive literature review on the: 1) use of RIA for canal reaming prior to intramedullary nailing; 2) use of RIA for the treatment of intramedullary osteomyelitis of long bones; 3) use of RIA for bone graft harvesting; 4) osteogenic potential of the RIA aspirate; and 5) future applications of the RIA system.