Inclusion Criteria:  Acute traumatic diaphyseal forearm fracture of the radius, ulna or both Fractures need to be complete (not unicortical or green stick) Displaced more than 50% of bone width or angulated more than 10° in any plane or irreducible or unstable after reduction  Exclusion Criteria:  We exclude patients  with fractures that are well managed conservatively (undisplaced or minimally displaced) with previous ipsilateral forearm fracture with fractures unsuited for intramedullary nailing (e.g. multifragmentary, metaphyseal or epiphyseal) with fractures with ipsilateral wrist or elbow involvement (e.g. Monteggia or Galeazzi variants) unable to participate in follow-up with existing bone pathology (e.g. tumor, osteogenesis imperfecta, degenerative disease) in whom internal fixation is otherwise contraindicated (e.g. active or potential infection)