Interosseous supply of the bone is there. Reaming though interferes with it but it also helps in robust healing as reaming increases vascularity to the area and interosseous bone grafts.

It is the same that oozes from medullary portion of bone when we perform curettage of bone as punctate bleeding also referred as 'paprika sign'.

The medullary vessels are also disrupted in conditions with increased interosseous pressure as in acute osteomyelitis or storage disease like Gaucher disease etc.

You are right Zahra. But the stability Iof I'M nailing is very important, on the other hand the revascularization that follows the reaming solves the blood supply problem.

The interosseous supply contributes little and is not the only supply as periosteal and surrounding soft tissues and muscles that are left intact in conventional closed nailing leaves little room for any significant impact of interferered blood supply due to reaming .

Yes Dr. Ganesh, you are right but I would not neglect the role of intraosseous blood supply, incl endosteal one. The theory and practice of the different types of pseudarthrosis confirm such considerations.

Reaming destroys interosseous blood vessels but the bone is bleeding into the canal via the destroyed vessels. The vast majority of the nails are fluted (they have grooves within their perimeter or they are not solidly cylindrical). The theory is that these "lagoons" of the "intramedullary haematomas" are directed through these grooves which act as "vessels" and thus the bone is receiving supply of blood even through the intramedullary area. It is found that at the end new vessels are created through these exactly grooves.

The blood supply needed for fracture healing following IM nailing is supplied by the periosteal vessels. It is thus necessary to be cautious with soft tissue handling ensuring minimal periosteal stripping particularly during open nailing.