Usoro AO, et al. - Authors estimated 47,169 cases under 14 studies comparing the combined rate of adverse events of acute vs delayed fracture fixation, and length of follow-up. They observed a 5.2% overall complication rate and malalignment >5 degrees of angulation in any plane as the most common complication, followed by delayed/nonunion, infection, and hardware failure. They observed good results of surgical implant generation network (SIGN) nails in fixing femoral, tibial, and humeral shaft fractures with a high frequency of return to full weight-bearing and radiographic/clinical union.