As an alternative to standard AO/Association for the Study of Internal Fixation plate and screw techniques, retrograde intramedullary locked nailing of supracondylar and intracondylar (AO/Association for the Study of Internal Fixation Type 33) fractures is reviewed. This includes a historic review, the technique for knee arthrotomy, fracture reduction and nail insertion, and the reported clinical and biomechanical results. The retrograde intramedullary locked nail is a viable alternative for the treatment of AO/Association for the Study of Internal Fixation Type 33-A and some C supracondylar femoral fractures and should be part of the internal fixation armamentarium, however, it does not replace the standard biologic plate and screw techniques for most fractures.