On biomechanical grounds, the largest possible nail diameter should be used, with minimal reaming, so as to minimize fracture site movement. Compression after meticulous reduction should be considered in axially stable fractures.
Clearance of the implant within the medullary canal, the flexibility of the implant itself, and the compliance of the implant (nail and locking screws) within the bone determine the extent of movement. The implant flexibility and the clearance are strongly dependent on the thickness of the intramedullary nail.
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