Reamer breakage in the femoral medulla during total knee arthroplasty

We present a case of intraoperative breakage of an intramedullary reamer in the femoral canal during a total knee arthroplasty (TKA). The reamer snapped at the junction of its distal and middle thirds leaving the distal fragment of the reamer at the level of the femoral isthmus. The broken part was in the middle third of the femoral medulla invisible from the lower part of the femur. That was removed using a Küntscher intramedullary nail inserted proximally through the piriformis fossa. After removing it from the knee joint, the TKA was performed as initially planned. Our case highlights the rare however potential complication of intraoperative instrumentation failure and raises requests of metal fatigue and failure with repeated use. Further to that a technical note is made describing how to remove the broken instrument from the femoral medulla and complete the planned TKA.