J Korean Orthop Assoc.  1990 Apr;25(2):359-367. 10.4055/jkoa.1990.25.2.359.

Treatment of Intertrochanteric Fractures of the Femur under 50 yrs. of age with Ender Nails


Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fractures of the elderly patients, but it has been rarely used in younger patients because of serious complications such as shortening and external rotation deformity. Authors already contended that the incidence of such complications had intimate connection with the quality of bone, and accordingly with the age. To substantiate the contention, we analyzed thirty-four cases with more than one year follow-up among forty cases of intertrochanteric fractures treated with Ender nails during the period from 1982 to 1989. And the results are summarized as follows;1. The average age was 39 yrs., and the most common cause of fractures was fall from a height. 2. According to the Kyle et al. clsssification, stable fractures(type I & II ) were 13 cases(38%), and unstable fractures (type III & IV) were 21 cases(62%). 3. According to the Singh's index, the good in bone quality(Grade 4, 5, & 6) were 31 cases(91 %), and the poor(Grade 1, 2, & 3) were only 3 cases(9%). 4. Postoperative complications occurred in 6 cases(17%), which included ROM limitation of knee joint in three cases(9%), proximal migrations of nails in two(5%), and distal migrations of nails in one(3%). Among them, 4 cases required revisional operations. There was no case with apparent external rotation deformity over 20 and shortening over 2cm. 5. It is thought that, contradictory to common beliefs, Ender nailingis a safe method for intertrochanteric fractures of femur in younger patients with good bone quality, but requires some experiences and cautions to prevent such complications as external rotation deformity and shorterning.


Ender nailing; Intertrochanteric fracture; Under 50 years of age
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