What is the Difference Between Cortical and Cancellous Screws

Multifix femur nails are designed to give surgeons more confident control over rotation in challenging femoral fractures, especially around the proximal and distal segments where standard nails can struggle. Their geometry, locking options, and overall construct all work together to keep the limb aligned as healing progresses.​

Why rotational stability matters in femur fractures?

Rotational malalignment in the femur is more than just a cosmetic issue; it can change gait, overload joints, and lead to long-term hip, knee, or back pain. In comminuted or segmental fractures, or when the break is close to the hip or knee, it becomes much harder to judge and maintain correct rotation throughout surgery and rehabilitation.​

Traditional intramedullary nails may provide good axial and bending stability but can be less reliable in controlling rotation if locking options are limited or poorly positioned. That is exactly the gap Multifix femur nails are meant to fill.​

Design features that support better rotation control

Multifix femur nails sit centrally within the medullary canal, but what makes them special is how they lock into the bone at each end. They typically offer multiple proximal and distal locking holes arranged in different planes and at varying offsets. This layout lets surgeons place screws so they “capture” key fragments and resist rotational forces more effectively than simple, single-plane locking designs.​

The nails are usually made from high-strength titanium alloy, which combines fatigue resistance with some flexibility, allowing the construct to share load with bone without compromising stability. The proximal end is often contoured to match the anatomy of the femur, helping maintain alignment and providing a solid base for proximal locking screws.​

How Multifix femur nails resist rotation?

Rotational stability depends on how well the implant and screws stop the fragments from twisting around the long axis of the bone. In Multifix femur nails, rotational control improves through several mechanisms:

• Multi-plane locking: Screws placed in different orientations create a three-dimensional “frame” at the proximal and distal ends, which is much harder to rotate under load.​
• Distance between locking points: Adequate separation between proximal and distal locking clusters increases the moment arm resisting rotational forces along the whole length of the fracture zone.​
• Close canal fit: Optimized nail geometry and diameters help the implant sit snugly in the canal, reducing play that could otherwise translate into subtle rotational shifts.​

In unstable or comminuted fractures where there is little cortical contact, these features become especially important. With limited bony interlock, the nail–screw construct itself must do most of the work of holding rotation.

Benefits in complex and peri-articular femur fractures

Complex femoral fractures around the subtrochanteric region or near the distal femur are notoriously difficult to keep aligned. Short metaphyseal fragments, wide canals, and strong muscle forces all tend to pull the bone out of position. Multifix femur nails, with multiple proximal and distal locking options, give surgeons more control points to neutralize these deforming forces.​

This allows:

• Better maintenance of femoral anteversion and limb rotation when there is heavy comminution or bone loss.​
• More secure fixation in distal or proximal fractures where standard two-screw constructs might allow subtle twisting over time.​

In some particularly demanding patterns, the nail’s superior rotational control can also complement adjunctive techniques such as cerclage wiring or small plates, which mainly help with fragment management while the nail guards length and rotation.​

Impact on healing and function

When rotational stability is reliable, surgeons can focus on restoring length and alignment with greater confidence and may allow earlier mobilization within safe limits. A stable, well-locked Multifix construct still acts as a load-sharing device, permitting controlled micromotion that promotes callus formation while avoiding the large, uncontrolled movements that cause malalignment.​

For patients, that translates into:

• A lower risk of rotational malunion and the gait disturbances that follow.
• A better chance of returning to near-normal limb function once union is achieved, with less need for corrective osteotomies later.​

In everyday practice, the combination of thoughtful locking design, anatomical shaping, and strong yet forgiving material is what makes Multifix femur nails a compelling option when rotational stability is a priority. By giving surgeons more precise control over how the femur is held in all planes—especially rotation—they help turn difficult fractures into more predictable, manageable cases.

To explore the advanced multifix femur and tibia nail system, visit booth N37.A71 at WHX Dubai 2026.