Rare Intraoperative Fracture of Intramedullary Reamer
Introduction: Intramedullary nailing is a common technique used to treat long bone fractures, however there is ongoing debate as to the use of reaming in these procedures. In this case, intramedullary nailing was undertaken; however, there was an intraoperative failure of the reamer causing the reamer to fracture. While there are several well-documented risk factors associated with reaming, equipment failure is not commonly reported. Case Summary: An 18-year-old male presented with a 2 year history of a right tibial stress fracture and pain with weight bearing. He elected to have an intramedullary nail placed with intraoperative reaming to stabilize the fracture and encourage healing. During the procedure the reamer fractured, and while the nail placement was ultimately successful the patient retained a small fragment of the fractured reamer within his tibia. Discussion: There are documented risk factors associated with intramedullary reaming, most notably with regard to the thermal effects on the bone during reaming and intramedullary pressure changes related to embolization, but reamer failure is not a commonly reported complication. While it has been shown that reamer failure has occurred in other cases, there is a lack of a standard quality assurance process to adequately assess the quality of the equipment prior to the procedure. Reamer damage of varying degree has been identified at other hospitals and attributed to wear produced during the reaming process, leading to increased strain on the reamer intraoperatively. The association of reamer dullness, fatigue failure, manufacturing/metallurgy defect, and monitoring cycles of use on complete reamer failure should be better characterized in order to create quality assurance standards. Conclusions: Reamer failure is a rare complication of intramedullary nailing. In addition, there is a lack of clear recommendations as to how to manage patients that have a retained foreign body from intraoperative reamer failure. While clinical management of these patients will depend on the individual case, development of a clear quality assurance procedure for reusable surgical equipment could avoid negative outcomes resulting from intraoperative reamer fractures.