Treatment of intertrochanteric and subtrochanteric fractures of the hip by the Ender method

Abstract

Ender's method of intramedullary fixation of intertrochanteric and subtrochanteric fractures is described. Ender's nail is a pre-bent flexible steel nail with a diameter of 4.5 millimeters. Three to five of these nails are inserted from a small incision proximal to the medial epicondyle of the femur into the medullary canal. They are passed through the femur across the fracture site and into the head of the femur, where they diverage. They are in the lines of force and therefore are not subjected to bending moments. The fracture fixation allows immediate weight-bearing. This method of fixation was used in a series of 203 patients. Their average age was sixty-eight years; the mortality rate was 10.3 per cent. In 3.9 per cent superficial infections occurred, but in no case was there a deep infection involving the bone. Functional return (walking) was achieved in all of the survivors who were able to walk at the time of injury, and there were no nonunions.