Internal or External?
By this I mean, should invasive or non-invasive procedures be favoured.
This can really only be decided on a case by case basis, but surgery generally allows patients to regain movement quicker and heal faster, however there is an increased infection rate. The method chosen has to consider both the success rate and the patients health and lifestyle.
Methods
Over the years many fracture repair methods have been invented. Generally speaking they fall into the following groups:
External Coaptation
The very basic repairs fall into this catagory. Splints, casts and banadages are all external coaptations. For simple, closed fractures external coaptation provides a low-tech, effective, and cost efficent solution, for these reasons they will probably 
remain at the forefront of treatment. However, they are unsuitable for treating complex fractures and for bone repair to occur perfectly the break and the coaptation must be aligned correctly.
Bone Plating
Bone plating is a repair solution that is used for more complex or difficult fractures. Plates serve the same purpose as casts, they hold the bone in position and support the break until natural healing occurs. The exact process of plating depends upon the nature of the fracture, but generally the fracture site will be opened to allow entry, blood and nerve supplies are diverted or cauterised. A metal plate, contoured to fit the break site, is attatched to the break and screwed into the bone either side of the break site. Due to the variety of support and anchoring that can be achieved using plates and screws it is a favoured method, and in routine use internationally.
Screws
Screws are usually used in conjunction with other surgical tools such as pins or plates, however they can be effective when used independently. A simple example of this would be when screws are used to hold the head of the femur during hip replacements.
Intermedullary Pins and Wires
Breaks in long bones can be repaired using intermedullary pins and wires, simply put these are rods (the pins) passed down
the inside of bones and wired or screwed (interlocking nails) into place.
External Fixators
"Ex-Fixes" as they are known, could be considered an improvement upon the plaster cast. External fixators come in many forms that all serve the same basic function, they hold the fracture in the correct position to allow correct healing. Common forms are metal cages around the site, anchored into un-injured bone, and using wires or pins to support the fragments (known as Ilizarov apparatus or circular fixations) and contoured rods holding pins in the correct positions (arm fixators).
Bone Grafting
In the case of complex fractures, or those where necrosis of the bone has occured, there will often be a gap where bone is missing when the fracture is correctly alligned. This "gap" is potentially a major problem, and can be solved using bone grafting. In grafting, bone is harvested from a non-essentially site (normally the hip, or an undamaged section of the damaged structure) and is inserted into the gap. This treatment leads to the bone graft growing, and hopefully filling the gap and repairing the damaged bone.
Bone grafting is often used in conjunction with "bone stretching", where ex-fixes are used with bone grafts and the distal ends of the fracture are slowly seperated to cause the bone graft to grow and fill the expanding gap. This allows the grafted bone to fill a gap much larger than itself, but is a slow and painful process.
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