Sequential reamer size increase
Reaming is performed in sequential steps by increments of 0.5 mm each.
As soon as chatter from cancellous bone can be felt and heard, the inner cortex has been reached. This may not be the case in segmental fractures or when severe comminution is present.
Adequate reaming must be performed to allow for smooth nail insertion. For example, for a nail width of 10 mm, drill bits of up to 10.5 or 11 mm diameter are used. If a very tight fit of the reamer can be detected before the desired reaming size is reached, one should consider using a smaller nail than previously planned.