Sequential reamer size increase
After the tissue protector has been introduced, the reamer shaft, fitted
with the initial reamer head is inserted over the guide wire. Usually, reaming
begins with a nine-millimeter, end-cutting medullary reamer.
Sequential reaming is performed with increments of 0.5 mm each.
As soon as “chatter” can be felt and heard, the inner cortex has been
Reaming must be performed to one or two increments above the planned nail
diameter, in order to allow a smooth nail insertion. For example, for a nail
diameter of 10 millimeters, reamer heads of up to 10.5, or 11, millimeters
diameter are used. If a very tight fit of the reamer can be felt before the
desired reaming size is reached, consider a smaller diameter nail than