RFN-Advanced Retrograde Femoral Nailing System
Christopher Finkemeier, Martin Hessmann, Mark Lee, Andrew Oppy, Karl Stoffel
Retrograde nailing of native and periprosthetic distal femoral fractures can be challenging due to:
- limited implant anchorage possibilities in far distal fractures,
- challenging implant placement in the presence of prosthesis components or other implants.
Insufficient implant anchorage may result in malunions, delayed unions, or nonunions requiring revision surgery. The new RFN-Advanced (RFN-A) Retrograde Femoral Nailing System was developed to address these issues. The Locking Attachment Washer (LAW) can be regarded as the most important innovation of the RFN-A System. The LAW concept allows to connect an anatomically shaped 6-hole plate (the locking attachment washer) at the lateral femoral epicondyle to the retrograde nail in an angular stable manner. The enhanced fixation options of the RFN-A will be beneficial to expand the retrograde nailing indications toward far distal fractures, to improve implant anchorage in poor bone quality, and to support early patient mobilization.
RFN-A Instruments
The instrumentation of the RFN-A is supported by the same set of basic instruments that is also used for the other nails of the Advanced Nailing System. There is a QUICK CONNECT LATCH mechanism to ease the assembly of the aiming arm to the insertion handle (Fig 1). The TWIST & LOCK technology allows to secure the protection sleeves in the aiming arm with one quarter twist.
The surgical technique of implanting the RFN-A was optimized based on anatomy lab experiences and finally confirmed in validation labs by evaluating every surgical step of the procedure (Fig 2).
Fig 1 The aiming arm is attached to the insertion handle by sliding it into the hook end of the insertion handle (1) and then rotating the aiming arm toward the insertion handle (2) such that the latch connects to the insertion handle. 
Fig 2 Karl Stoffel (Chair of the former AO TC Periprosthetic Fracture Task Force and medical member of the AO TC Lower Extremity Global Expert Committee) during a validation lab assessing each step of the surgical technique guide according to a checklist. Innovations in retrograde femoral nailing: Retrograde Femoral Nail Advanced
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