Proximal locking or distal locking first?
If the length is correct, proximal locking screws are inserted first, and then the insertion handle is removed.
The knee is then extended and the distal locking is performed, with fluoroscopic guidance using instrumentation and technique chosen by the surgeon.
If the fracture is distracted, distal locking is performed first with 2–3 screws, and the nail is pulled back with gentle hammer blows until fracture contact is achieved (see “Backslap technique”). Recheck the proximal end of the nail, which should not protrude proximally.