Use of a Retrograde Guidewire to Direct an Antegrade Femoral Nail

Antegrade intramedullary nailing for the treatment of diaphyseal femur fractures may present challenges in obtaining appropriate positioning of the distal tip of the nail. Known mismatch between the radius of curvature of commonly used nails and the anatomic bow of the femur may result in impingement or perforation of the anterior cortex of the distal femur. Additionally, some unique scenarios may arise that complicate traditional antegrade wire passage. We report our surgical technique and clinical experience using a retrograde guidewire to direct an antegrade femoral nail to aid in obtaining a desired central location of the distal nail tip.