Rigid intramedullary nailing is an effective procedure for treating fractures of the femoral shaft. Although antegrade nailing is the traditionally used technique, retrograde nailing offers various advantages. A companion article published in the seventh volume of The University of New Mexico Orthopaedics Research Journal addressed antegrade femoral nailing. This review will describe retrograde nailing of femoral shaft fractures, including a brief history, indications, detailed technique, outcomes, advice (or “pearls”), and common failures (or “pitfalls”). Retrograde nailing for treating femoral shaft fractures can provide successful results similar to those of antegrade nailing in general and advantages in particular situations such as more distal shaft, bilateral, and certain associated fractures.

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