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10Nail insertion

General considerations

During nail insertion, it is important that the assistant apply traction to the lower extremity, in order to prevent shortening and/or angulation of the distal main fragment. In order to prevent this complication, which is very difficult to correct later, repeated image intensifier assessments are required.

Nail insertion
Drive the nail gently into the distal fragment. This can often be performed manually. If required, gentle hammer taps are usually sufficient to ensure proper advancement. Insert the nail until it just passes deep to the cartilage surface.

Take care in osteoporotic oblique and multifragmentary distal femoral fractures not to shorten the femur by impacting the bone ends too firmly together.