Of seven patients with complications caused by penetration of the distal locking device through the distal femur, three had penetration of the distal locking device into the knee joint. Two patients had penetration into the patellofemoral joint. One patient had penetration into the lateral cortex of the distal femur and another patient had penetration into the medial cortex of the distal femur. AH but one patient required removal of the rods and/or the distal locking device. The main causes of complications include rod rotation, previous surgery, preexisting deformity of the femur, and failure to insert the rod into its proper location distally.