Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN)


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Learn the Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN) surgical procedure.


The retrograde/antegrade femoral nail (RAFN) is a versatile system whose benefits include:

  • One system of instrumentation for retrograde and antegrade insertion.
  • One system / implant for left and right femurs.
  • An anatomic anterior bow that allows easier nail insertion.
  • All nails are cannulated and can be inserted with either a reamed or unreamed technique.
  • There is a large range of nail diameters available 9.0 mm to 15.0 mm
  • There are multiple locking options including; static, dynamic, standard and blade options for osteoporotic bone.

It should be noted that a distal femoral nail is inserted with a retrograde technique and in some literature the words are often used to mean the same thing. However, this shouldn’t be confused with an antegrade nail (e.g. Lateral Femoral Nail – LFN) that is used to treat a distal third femoral fracture.

In a retrospective series by Kim et al., sixty patients undergoing femoral nailing for infra-isthmal fractures were reviewed. Thirty-eight patients were treated with an antegrade nail and twenty-two patients with a retrograde nail. They report no statistical difference in time to union, no difference in malalignment > 10 degrees and no difference in Knee Society scores. They did however find that the IM nail with the shorter working length distal to the fracture showed a strong relationship with nonunion.

In a systematic review and meta-analysis by Koso et al., they report that femoral shaft fractures developed nonunion in 6.6% of unreamed nails and 2.1% of reamed nails (p = 0.002). Therefore if the patient’s physiology will permit reaming of the femoral canal, this lowers the risk of developing a nonunion.

Kim JW et al. Treatment of infra-isthmal femoral fracture with an intramedullary nail: Is retrograde nailing a better option than antegrade nailing? Arch Orthop Trauma Surg 2018;138(9):1241-1247. 

Koso RE et al. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop 2018;42(11):2675-2683.

Readers will may also find of use the following OrthOracle techniques:

Open reduction and internal fixation of an open intra-articular distal femoral fracture with Synthes LCP distal femoral plate

Femoral intramedullary nail: Synthes Expert Lateral Femoral Nail (LFN) for impending pathological fracture.

Tibial intramedullary nailing (suprapatella approach): Synthes Expert Tibial Nail.

Author:Mr Ross Fawdington FRCS (Tr & Orth)

Institution: The Queen Elisabeth Hospital, Birmingham, UK.

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity


Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.


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