The nail is coupled to an insertion handle via a nail extension. It is introduced along the anatomical axis of the femur and inserted into the medullary canal of the proximal segment by hand or gentle hammering. The fracture is aligned while the nail is further advanced into the distal segment.
The nail is directed into the distal segment using fluoroscopic guidance, closed palpation, or visualization through an open-but-do-not-touch approach to the fracture site. A mallet is used to fully impact the nail into the intramedullary canal, until deeply seated in the distal metaphysis or epiphysis.