Insert the cannulated, flexible-shaft reamer over the ball-tipped guide wire.
Begin with an end-cutting reamer and proceed sequentially to larger reamer diameters, usually in increments of 0.5 mm. Protect the soft tissues at the entry site during this process with a reamer sleeve, as shown, or suitable retractors.
Do not force the reamer! While advancing, intermittently pull back a little to clear debris from the medullary canal.
A chattering sensation indicates that the reamer is in contact with the internal cortical surface. A millimeter or two of additional reaming usually permits passage of an appropriate diameter nail.