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8Insertion of the cannulated nail

Nail insertion

Nail insertion

With adequate reduction and sufficient over-reaming, it should be possible to insert the cannulated nail over the guide wire by hand, or with gentle hammering. Ensure that reduction is maintained as the nail crosses the fracture. If insertion is difficult, correct the reduction and/or remove the nail and ream to a larger diameter.
Make sure that the proximal end of the nail is below the surface of the bone at the entry site, to decrease the risk of knee pain. Careful choice of nail length may be necessary, particularly for distal fractures, to ensure both distal fixation and proper length proximally.