Under no circumstances should they be reversed or the wire will uncoil with catastrophic selleckbio results. In our case reversal of the coil was not done but this did not prevent the reamer from uncoiling. Several factors may be responsible for this complication. Firstly, in our case reaming was initiated with 10-mm coil which may have contributed to uncoiling. Reaming should be initiated with the Flexible Shaft with 9.0-mm front-cutting reamer and progressed in 0.5-mm diameter increments.[5] The reamer should be advanced with a steady, moderate pressure. At no time should it be forced into the canal. Partially retract the reamer often, to clear debris from the medullary canal. This prevents the reamer head from jamming in the medullary canal.

If the reamer does get stuck inside the medullary canal, gentle use of the drill may free the reamer and a small�Cdiameter reamer should then be used. Care should be taken when reaming across the fracture site as there may be some cortical damage, unless the fracture is properly reduced.[6] If possible, the reaming rod should not be withdrawn across the fracture site. The position of the reaming rod should be reconfirmed with image intensification after this procedure. Reaming should always be carried out so that the resultant track in the medullary canal is 1-mm wider than the intramedullary nail that the surgeon proposes to use. If reaming is difficult, than the surgeon may choose to ream only 0.5 mm more than the nail, but this is hazardous as the nail may get stuck and be impossible to remove, moreover the reamer may uncoil.

In our case once the flexible reamer uncoiled, it was not possible to remove it simply by pulling. Once uncoiling has occurred, further reaming in clockwise or anticlockwise direction may lead to more uncoiling. A slotted hammer may be positioned over the reamer against the drill attachments and the assembly tapped out. If these manoeuvres are unsuccessful, open operative removal will be necessary but fortunately this was not required in our case. The tapping out of the assembly lead to the removal of guide wire also. This may occur since due to uncoiling effect, the coils of the reamer has tightly gripped the guide wire and it will not be possible to push it alone. Once the assembly was removed, it was not possible to isolate the reamer and the guide wire, so a new guide wire was again inserted and nailing was then completed.

Another reason contributing to this unique Anacetrapib complication is the use of an indigenous implant made of poor quality stainless steel. It should be noted that the instrumentation should be of good quality and not be too old. Repeated use of the same reamer over a long time in multiple surgeries may cause wear and tear of the coils and that can cause such complications. CONCLUSION This case highlights the dangers associated with reamed interlocking nailing if proper techniques are not followed and good instrumentation are not used.