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- Indications:
    - ipsilateral femoral and tibial shaft fracture;
    - fractures with intra articular extension into the ankle or knee
    - segmental fractures
         - closed treatment of segmental tib frx has nonunion rate = 50%
         - IM Nailing yeilds best treatment
         - type 3B open frx are limb threatening
         - type 3C usually result in amputation;
    - bilateral fractures
    - open fractures
    - frx associated w/ vascular complications (compartment syndrome)
    - Ex Fix or IM nailing (especially with compartment syndromes)
    - failed closed treatment
    - pathologic fractures