Tier 6

Principles

Vascular watershed area with high non-union risk (15-30%) in non-operative management. Union approaches 100% for those managed operatively.

Even if union achieved, there is high risk of re-fracture (33%).

Management

Most are considered for operative management.

• Intramedullary screw fixation.
• Plate fixation usually reserved for those with failed IM screw fixation.

Non-operative management considered for low-demand and frail patients.