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.
Recommendations:
(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
