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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 reached.

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 previously planned.