Introduction: Treatment of supracondylar and intercondylar fractures of the distal femur is a challenge for most orthopaedic surgeons and has been changing for the last few years with the introduction of retrograde nailing.

Methods: The authors review all type A and C fractures submitted to surgical treatment, in our department, in the period between 1995 and 2005.

Of the 120 fractures (in 117 patients), 16 were excluded from our study (10 patients were followed in other institutions and 6 died of non-related causes).

From the total of 104 fractures reviewed 77% had been submitted to rigid internal fixation with extramedular devices (95 Blade plates, DCS, Condylar plates, etc) although in the last few years (since 2000) the use of intramedular retrograde nailing has became the standard form of treatment (16 type A and 8 type C, including 2 C3).

Results: Despite the gap in follow-up (96,5 months in the extramedular group and 39,6 months in the intramedular) significant differences were observed regarding: inicial and late complications, time to fracture healing, non and mal-unions, need for re-operation, final clinical results and patient satisfaction.

Conclusions: Retrograde nailing of the femur is a simple technique which allows early mobilization of the knee while maintaining excellent stabilization of the fracture. It’s a more biological fixation, it offers greater soft tissue preservation and lesser need for bone grafting.

In our experience the application of retrograde nails in type A fractures and the combination of multiple screws fixation and retrograde nails in type C fractures provide the best results.