Variations in surgical preferences exist with regard to the optimal length
of a retrograde nail for treatment of a distal femoral fracture.
Determine nail length using a guide wire
If reaming was performed, the maximal length of the nail is determined by
comparing a second identical length guide wire to the one that has been
inserted. The correct placement of the tip of the guide wire in the proximal
canal should be assessed using an image intensifier. A second guide wire must
be positioned in contact with the articular surface of the distal femur. This
must also be verified by image intensifier.
It is desirable to use the longest nail possible in the femur to prevent
latent risk of periimplant fractures.