ASPECTS OF CURRENT MANAGEMENT The biological and physiological effects of intramedullary reaming

The development of intramedullary nailing, introduced in 1939 by Küntscher, 1 revolutionised the treatment of fractures of the long bones. Initially, this mechanism of stabilisation consisted of the maintenance of close contact and friction between the implant and the inner cortex by a cloverleaf nail. The technique was limited to simple fractures of the midshaft only. Once established, reaming became an important addition to the method. The process of reaming has attracted extensive research and has been shown to be associated with a number of biological effects, including the alteration of the medullary blood supply, fat embolisation, autografting and the generation of thermal energy. 2-6 Since the development of locked nailing, the indications for intramedullary stabilisation have been expanded further, thus providing a broad spectrum of options for the management of a variety of fractures. 7 This review describes the anatomy and physiology of intraand extramedullary changes induced by reaming of the medullary canal in fractures of the long bones.