General considerations

A3 is the most suitable fracture pattern for nailing. Transverse fractures indicate a high-velocity trauma and careful examination for associated injuries should be performed.
Nonoperative treatment | ||
Main indication | Skill | Equipment |
---|---|---|
Shortening and displacement < 2 cm | ![]() |
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Supporting indications
- Situations where larger interventions are contraindicated
Advantages
- No surgery
Disadvantages
- Immobilization up to 6 weeks
- Yield more incidences of nonunion or shortening
Contraindications
- Open fracture
- Neurovascular injury
- Risk of skin penetration by bone
ORIF - Compression plate | ||
Main indication | Skill | Equipment |
---|---|---|
Shortening and displacement > 2 cm | ![]() |
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Supporting indications
- High demand patients
- Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)
Advantages
- Less pain and quick recovery of function (early return to work)
Disadvantages
- General surgical risk
- Risk of compromising subclavicular neurovascular structures
- Prominent hardware necessitating hardware removal
- Potentially poor cosmetic outcome (scar)
Contraindications
- Infection
-
Metal allergy
Flexible intermedullary nail | ||
Main indication | Skill | Equipment |
---|---|---|
Shortening and displacement > 2 cm | ![]() |
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Supporting indications
- High demand patients
- Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)
Advantages
- Less pain and quick recovery of function (early return to work)
- Minimally invasive procedure
- Small scars
Disadvantages
- General surgical risk
- Risk of compromising subclavicular neurovascular structures
- Prominent pin end necessitating secondary pin shortening
Contraindications
- Narrow intramedullary canal
- Infection
-
Metal allergy
*Skill | |
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Basic surgical experience, no specialized skills |
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Some specialized surgical experience |
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Highly experienced and skilled surgeon |
*Equipment | |
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Basic equipment only |
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Simple surgical and imaging resources |
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Full specialized surgical and imaging resources |