The reamer won't come out! An unusual complication of intramedullary nailing of femur fracture

Intramedullary nailing has become the gold standard in surgical treatment for long bones shaft fractures. Even in expert hands, many intraoperative complications may occur. We report an unusual complication of trapped bone fragments between the reamer and the cortex during intramedullary nailing of a simple femur shaft fracture. All Attempts to withdraw the reamer were unsuccessful. The fragment had to be removed through an open incision. This complication was probably caused by a migrated chip of cortical bone fragment from the inner cortex which caused incarceration of the reamer. If a loose intramedullary fragment is noted during reaming or nailing, it must absolutely not be ignored.