Guide wire insertion
A guide wire is advanced into the distal main fragment until it is about 5 mm proximal to the intercondylar notch. It is important that the guide wire be centered to prevent eccentric reaming and subsequent malposition of the nail, which can result in varus/valgus/antecurvatum/retrocurvatum malalignment.
Unreamed nailing does not require a guide wire. When unreamed nailing is performed, the nail is used as a reduction tool.