A 35-year-old motorcyclist sustains a closed tibial shaft fracture. Intramedullary nailing is planned. Reaming of the canal is performed. Which of the following statements best describes the biological consequence of reaming on fracture healing?
- A Reaming eliminates both endosteal and periosteal circulation permanently, delaying healing
- B Reaming destroys the endosteal blood supply but compensatory periosteal hypervascularity more than compensates within 8–12 weeks ✓
- C Reaming has no effect on cortical vascularity because tibial cortex is exclusively supplied by periosteum
- D Reaming stimulates endosteal new bone formation immediately by activating bone morphogenetic proteins locally
Correct answer: B. Reaming destroys the endosteal blood supply but compensatory periosteal hypervascularity more than compensates within 8–12 weeks
Explanation
Intramedullary reaming destroys the endosteal blood supply (which normally provides the inner two-thirds of cortical perfusion). However, the periosteal circulation responds with compensatory hypervascularity that is restored and exceeds baseline by 8–12 weeks, ultimately supporting fracture healing. Permanent elimination does not occur, and the periosteum is not the exclusive supply. Reaming does not acutely stimulate BMP-mediated bone formation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.