Critical analysis of Ender nailing in the treatment of trochanteric fractures.

A consecutive series of 152 trochanteric fractures treated by Ender nailing has been analysed. The mortality was 5% after 3 weeks and the infection rate 2.6%. The follow-up was attended by 139 patients, 41 having had stable and 98 unstable trochanteric fractures. In the group with stable fractures, secondary displacement of the fracture or the nails occurred in 12% and knee pain in 32%, necessitating re-operation in 22% of these patients. The corresponding figures for the unstable fractures were 64% secondary displacement, 59% knee pain and 46% reoperations. The results are discussed and it is concluded that, with an improvement in fracture reduction and operative technique, it may be possible to successfully treat stable trochanteric fractures with Ender nailing. However, this method cannot be recommended for unstable trochanteric fractures.