Retrospective Level I trauma center study of 198 femoral shaft fractures directly comparing outcomes of retrograde (n=104, intercondylar starting point) versus antegrade (n=94, piriformis fossa) intramedullary nailing performed by the same three surgeons over the same period.
When choosing between retrograde and antegrade nailing, think of it as trading hip morbidity for knee morbidity: retrograde avoids heterotopic ossification and hip pain but carries a 36% knee pain rate and risk of intra-articular complications, making it the preferred approach for distal-third fractures, obesity, polytrauma with ipsilateral pelvic/acetabular injuries, and ipsilateral femoral neck fractures — while antegrade remains preferable when protecting the knee is the priority.
Retrospective Level I trauma center study of 198 femoral shaft fractures directly comparing outcomes of retrograde (n=104, intercondylar starting point) versus antegrade (n=94, piriformis fossa) intramedullary nailing performed by the same three surgeons over the same period.
When choosing between retrograde and antegrade nailing, think of it as trading hip morbidity for knee morbidity: retrograde avoids heterotopic ossification and hip pain but carries a 36% knee pain rate and risk of intra-articular complications, making it the preferred approach for distal-third fractures, obesity, polytrauma with ipsilateral pelvic/acetabular injuries, and ipsilateral femoral neck fractures — while antegrade remains preferable when protecting the knee is the priority.