While there is some evidence to suggest that early fixation of the fractured femur( ＜ 24 hours)may be associated with improved outcome, the lack of comparablestudy populations leaves this question largely unanswered. Prospective and/orrandomized studies that control for injury severity are needed to answer the question of optimal timing for fixation of the femur.

It appears that unreamed nailing is significantly faster (operative time) with less blood loss compared with unreamed nailing in the treatment of femoral shaft fractures; however, reamed nailing contributes to faster union times and fewer delayed unions. Neither appears to significantly increase the risk of other complications including pulmonary compromise. Functional outcomes cannot be determined.

Risk factors associated with poorer functional outcome after shoulder arthroplasty varied widely by study and by fracture type. The most common risk factors were increased age and greater tuberosity displacement or osteotomy. The overall functional and postoperative outcomes after shoulder arthroplasty were favorable across most studies. However, some studies were of poorer quality resulting in low methods scores and, therefore, the results of these studies should be viewed with caution.

There is some evidence to suggest superior results of surgical treatment that includes open reduction internal fixation (ORIF) or percutaneous pin fixation (not including Kapandji pinning) to stabilize fracture fragments and improve functional ability compared with conservative treatment. However, larger studies with longer follow-up are needed to verify these results.