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1Principles

Illustration comparing various implant types.

Choice of implant

For retrograde femoral nailing to achieve adequate fracture stabilization, the fracture should be at least 6 cm from the joint line to achieve distal locking with two transverse screws or a screw and a spiral blade. In contrast, more distal fixation can be achieved with plates, or locked fixators. For example the distal most screws in a LISS plate, or a condylar plate, may be subchondral.

The distal most fixation for various implants are:

  • LISS plate: subchondral
  • Condylar plate: subchondral
  • 95° angled blade plate: 1.5 – 2 cm
  • 95° dynamic condylar screws: 2 cm
  • Retrograde intramedullary nail: 6 cm (for 2 locking screws, or one locking screw and a spiral blade)