Reaming the tibia prior to placing an intramedullary nail for fracture repair may be associated with thermal damage. This is caused by excessive friction, which generates transient heat. This heat can result in a number of complications.


Risk factors for excessive friction while reaming:

(1) reamer larger than the diameter of medullary canal (with cutting into cortical bone)

(2) greater distance reamed

(3) dull or blunted reamer blade following repeated use

(4) reaming rapidly without a chance to cool down

(5) prolonged application of excessive force


Problems tended to occur when a smaller medullary diameter (8 mm or less) was reamed to a larger diameter.



(1) Ream the medullary diameter in small increments (no more than 0.5 mm).

(2) Make sure that the reamer blades are sharp.

(3) Hand ream narrow medullary cavities, avoiding excessive force.


Complications associated with thermal burns:

(1) osteonecrosis

(2) fracture nonunion

(3) osteomyelitis


Other complications of reaming:

(1) increased risk of marrow emboli to the lung secondary to increased pressure

(2) damage to tendons and soft tissue

(3) damage to intra-articular structures


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