Intertrochanteric fractures: a comparison between fixation with a two-piece nail plate and Ender's nails. Intertrochanteric fracture of the hip. Comparison of nail-plate fixation and Ender's nailing. [Pertrochanteric fractures. Comparison between 2 surgical methods of internal fixation]. A comparison of nail-plate fixation and Ender's nailing in pertrochanteric fractures. Trochanteric and subtrochanteric fractures. The operative results in a prospective and comparative study of Ender nailing and McLaughlin Osteosynthesis. Treatment of intertrochanteric fractures: comparison of Ender nails and sliding screw plates. Clinical features and walking ability in the early postoperative period after treatment of trochanteric hip fractures. Results with special reference to fracture type and surgical treatment. The use of Ender's pins in extracapsular fractures of the hip. Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw.
The progress of 182 patients who presented with intertrochanteric fractures was followed over a six month period. Eighty-seven patients were treated using Thornton/McLaughlin nail plates and 95 were treated using Ender's intramedullary nails. Each fracture was classified according to radiological position and mechanical stability. The results show that the more unstable fractures are more likely to develop unsatisfactory results. Post operatively, the different mechanical complications have been recorded at various stages. Those fractures fixed with a nail plate tended to develop varus deformity resulting from either bony collapse around the implant or implant failure, whereas those fixed with Ender's nails did not develop deformity at the fracture site but encountered distal migration of the nails at the knee. The use of a classification system in predicting post operative mechanical complications is considered, and the comparative merits and disadvantages of the two fixation systems is discussed, with suggestions for improvement in operative technique. Between April 1979 and August 1983, 201 patients with intertrochanteric fractures of the hip were admitted to Haife Medical Center (Rothschild), Israel. These patients were randomely divided into two groups: 104 patients underwent fixation with a compression screw and plate (Richard's Co.) and 97 patients underwent fixation with Ender's nails. The results of both groups were analyzed and evaluated clinically, economically, and socially. There were differences in operative time, incidence of infection, local complications, and functional capacity, but, on the other hand, no difference in the length of hospital stay. The perioperative mortality was significantly higher in the group that underwent fixation with Ender nails (seven to one), but the overall mortality was the same for both groups. The advantages of the Ender method are a quicker surgical procedure, diminished blood loss, and practically no risk of deep infection. The fixation with compression screw and plate assures a better anatomical reduction of the hip with fewer local complications and a better functional result, but carries a higher risk of infection. nan A randomized comparison was made of condylocephalic (Ender) nails and a nail-plate technique (McLaughlin) for fixation of trochanteric fractures, to evaluate the consumption of acute hospital bed-days, number of reoperations, peroperative blood loss, and operation time. Reoperations were performed in 30% of the Ender group and in 10% of the McLaughlin group and blood loss was doubled for the McLaughlin method. Our study has shown, that in our hands, patients operated on with Ender nails had more reoperations, but in spite of this the total cost, in the form of days in hospital or operation time was not increased. A comparative and prospective study was performed in order to evaluate the advantages or disadvantages of the Ender operation in comparison with the McLaughlin technique. The series included 145 patients, 72 operated by the Ender method, and 73 by the McLaughlin method. There were no differences between the two groups as regards anaesthesia time, operation time, mean stay in hospital, morbidity and mortality. Technical problems were encountered in 40 of the Ender operated fractures (56 per cent), whereas the figure for the patients treated with the McLaughlin method was 17 (23 per cent). Ten (14 per cent) patients in the Ender group but only 2 (3 per cent) in the McLaughlin group needed re-operation. Three deep infections occurred in the McLaughlin group, but non in the Ender group. It was concluded that the only advantage which could be demonstrated in the Ender group was a low infection rate. Many disadvantages were revealed, the most outstanding being the many technical problems encountered and the great number of re-operations required. The results of two fixation devices for the treatment of intertrochanteric fractures were compared in 220 patients--163 women and 57 men with a mean age of 81 +/- 10 years. One hundred and one patients were randomized to Ender nailing and 119 to fixation with a sliding screw plate (SSP). The two treatment groups were equal with respect to important preinjury variables. The two methods did not differ in operating time or perioperative blood loss. The proportions of good reduction of the fractures and of good positioning of the internal fixation devices were equal in the two groups. But the complication rate and the reoperation rate were more than twice as high in the Ender group than in the SSP group. The outcome at 1-year follow-up was approximately equal in the two groups. The purpose of this study was to analyze the functional outcome during the early postoperative period (six weeks) in patients with trochanteric fractures. A consecutive series of 149 patients were randomized to treatment with either the DHS or Ender operative technique. 120 patients were available at review six weeks after surgery. Groups were comparable with respect to age (mean 77 years), sex ratio (73% women), type of fracture (59% and 55% unstable), experience level of the surgeon, prefracture health condition and ambulatory status. During follow-up eight patients died and there were 19 complications of neurologic and cardiovascular types equally spread among the two groups. All four infections were found in the DHS group. Orthopaedic hospital stay averaged 19 days and more patients in the Ender group could return to their previous home at time of discharge. At the six week visit 14% in the Ender group compared to 33% in the DHS group had not recovered functional walking distance (less than 15 m). All patients in the Ender group managed to walk, but 11% of the patients in the DHS group could not walk. Walking ability was most impaired for unstable fractures. It is concluded that the Ender technique will involve less operative trauma (shorter operations with less blood loss) and in the early postoperative period it can provide better conditions for walking and less need for further hospitalization than the DHS technique. In October 1976 a randomized, paired, prospective study comparing the compression sliding hip screw with Ender's pins in the treatment of extracapsular hip fractures was begun on the orthopaedic service at San Francisco General Hospital. The results in 100 patients with a minimum follow-up of six months showed that Ender's procedure required less operative time, had less blood loss, and had a lower postoperative incidence of medical complications. A 26 per cent incidence of technical problems with Ender's pins (such as postoperative backing-out of the pin) required reoperation in 16 per cent of the patients compared with an 8 per cent rate of reoperation in patients treated with the compression screw. The majority of these complications occurred in unstable fractures. There were no deep infections in the patients with Ender's pins but a 6 per cent incidence of deep infection was seen in those with the hip screws. There were no non-unions in either group. Although hip function at follow-up was equal in both groups, there was a 41 per cent incidence of postoperative pain and stiffness of the knee in the group with Ender's pins. It is our opinion that Ender's pins are a valuable addition to the armamentarium of surgeons treating extracapsular fractures of the hip and are ideally suited for elderly patients with stable fractures, particularly if the surgical risk is high. They must be used with caution in unstable fractures and postoperative protection in traction may be necessary. However, the occasional external rotation deformity and the high incidence of problems with the knee makes their use in younger, more active patients less desirable than the compression hip screw unless their unique advantages justify their use. In a prospective, consecutive, randomized study of the treatment of unstable intertrochanteric fractures of the hip, the use of Ender pins was compared with the use of the compression hip-screw. There were more than 100 patients in each treatment group. The patients who were alive six months postoperatively were evaluated. The number of secondary operations was much higher in the patients who were treated with Ender pins, and a considerably higher number of those patients had loss of fixation. The use of Ender pins that were too long and a history of a fracture before the operation in which Ender pins were used were statistically significant predictors of secondary operations.
Any advantages in intra-operative outcomes of condylocephalic nails are outweighed by the increase in fracture healing complications, reoperation rate, residual pain and limb deformity when compared with an extramedullary implant, particularly a sliding hip screw. The use of condylocephalic nails (in particular Ender nails), for trochanteric fracture is no longer appropriate.