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 |  |
 |
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 |  |
 |
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 | |
 |
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 | |
|---|---|
|
Basic surgical experience, no specialized skills |
|
Some specialized surgical experience |
 |
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
|
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |