At present, medullary nailing by the method of Küuntscher is the best treatment for transverse closed fractures, for open fractures, and for most of the osteotomies and non-unions of the shaft of the femur, if suitable equipment is available. The union of the fragments is so firm that the patient can walk without additional fixation after the wound has healed,—that is, in two or three weeks. Thus muscle atrophy and stiffness can be almost entirely prevented. With closed medullary nailing, the danger of infection is slight, because only a small incision is made apart from the fracture site. With open medullary nailing, the danger of infection is reduced by exact immobilization.
The authors also use medullary nailing for closed transverse fractures in the middle third of the shaft of the humerus. They no longer employ this method for fractures of the tibia or the forearm, as conservative methods have proved to be bettet.
Medullary nailing is a technically difficult procedure and sisould, therefore, be done only in specially equipped hospitals.