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In the adult, intramedullary nailing of forearm shaft fractures is only acceptable when the injury is such that anatomical reduction and plate osteosynthesis are strongly contraindicated. Such circumstances include crushing injury of the forearm with major soft-tissue mutilation (as in the illustrated case), the presence of extensive burns, and multiple skeletal injuries presenting a major pathophysiological challenge.

This clinical image shows a major crush injury of the forearm with multifragmentary fractures of both bones.