Most femoral shaft fractures are treated with intramedullary nailing where practical. This gives the strongest mechanical fixation and is the best treatment for early mobilization.
Nonoperative treatment is undertaken only temporarily. Nonoperative treatment is reserved for exceptional cases, e.g. if the general medical condition does not allow safe anesthesia.
Relative stability is not suitable for transverse, or short oblique, single plane fractures, because all the implant and tissue strains are concentrated at one place; absolute stability with no interfragmentary motion is required. This is achieved by compression plating, which requires an open technique.