The first principle to decrease the revision rate is to ensure sufficient purchase. The thread of the male component needs to be fully submerged into the epiphysis, and the flange (*) of the nail must exceed the physis or at least stop at the level of the physis. If the distal epiphysis of the tibia is small, the tip of the nail may reach the subchondral area (arrow) to ensure that the whole thread goes through the physis.