Prospective RCT comparing antegrade (fracture table) vs retrograde (radiolucent table) reamed intramedullary nailing in 68 patients with 69 femoral shaft fractures, evaluating union rates, alignment, complications, and knee symptoms.
When choosing retrograde femoral nailing, use a femoral distractor and lock proximally first to control rotation — without a traction table, one-third of unstable (Winquist 3–4) fractures will have >10° of rotational error; reserve retrograde nailing for cases where antegrade access is genuinely compromised (obesity, floating knee, ipsilateral acetabular fracture) rather than as a routine alternative.
Prospective RCT comparing antegrade (fracture table) vs retrograde (radiolucent table) reamed intramedullary nailing in 68 patients with 69 femoral shaft fractures, evaluating union rates, alignment, complications, and knee symptoms.
When choosing retrograde femoral nailing, use a femoral distractor and lock proximally first to control rotation — without a traction table, one-third of unstable (Winquist 3–4) fractures will have >10° of rotational error; reserve retrograde nailing for cases where antegrade access is genuinely compromised (obesity, floating knee, ipsilateral acetabular fracture) rather than as a routine alternative.