Reduction of temperatures generated by the triple reamer within the femoral head

The triple reamer is a convenient tool for reaming the proximal femur when using a sliding screw and plate device, but unnecessarily high temperatures may be generated within the femoral head while the lateral cortex is being reamed. Nineteen female patients over 60 years old were randomized to either the standard or a modified reaming technique with the triple reamer during internal fixation of proximal femoral fractures. Temperatures generated within the femoral head were measured. Results showed a mean peak temperature of 51.9 degrees C (range 42-66) using the standard method and 46.3 degrees C (range 40-52) using the modified method (P = 0.07). A significant difference (P < 0.05) was found in the duration of temperature elevation above the critical 44 degrees C (17.4s vs 5.7s), it being prolonged in the standard group. Even in this osteoporotic patient group, damaging temperatures which may contribute to the mechanical failure of fixation, are generated within the femoral head. A simple method to avoid this problem is described.