Uncoiling of reamer during intramedullary nailing for fracture shaft of femur
A 28-year-old male presented to the emergency department after a road traffic accident in which he was riding a motorcycle and was hit by a truck at a speed of approximately 60 kilometres per hour. He was brought with a grossly deformed right thigh and complained of pain in his right thigh and the inability to move it. An examination of his extremities revealed contusions over his right thigh without any evidence of penetrating injury. There was marked swelling and tenderness in the middle part of his right thigh associated with a closed injury. There was no distal neurovascular deficit. In view of the above clinical findings, a radiograph of his right thigh was suggested. The radiograph revealed unilateral displaced comminuted fracture of shaft femur []. Our patient was then given first aid in the form of Thomas splint and he was planned for reamed interlocking nailing.\nHe was taken to the operating room and was placed supine on a fracture table. After cleaning and draping in a standard fashion a greater trochanter entry point was made. To hasten the surgery the surgeon started with a reamer of 10 mm and whole canal was reamed over beaded guide wire. While removing the reamer from the canal, the reamer got stuck and it was neither going forward or backwards. An intraoperative image showed uncoiling of reamer. Further reaming in either clockwise or anticlockwise direction led to increased uncoiling of the reamer []. It was not possible to remove the assembly by pulling it out. A slotted hammer was positioned over the reamer against the drill attachments and the assembly was tapped out. Unfortunately, this led to the removal of the guide wire along the reamer []. A new guide wire was then again reinserted through the entry point into the canal and the procedure of interlocking nailing was completed successfully [Figures and ]. At six months’ follow-up the fracture had united and patient had resumed his occupation.