Ender nailing for peritrochanteric fractures of the femur. An analysis of indications, factors related to mechanical failure, and postoperative results.

Of 100 patients with a peritrochanteric fracture of the femur treated by the Ender technique, we reviewed the cases of seventy-nine after an average follow-up of 11.4 months in order to clarify the indications for the procedure and investigate variables that may affect the results. The variables that correlated with the failure rate appeared to be the quality of the reduction, the number of nails used, the experience of the surgeon with the technique, and the degree of fracture instability. Nail placement in terms of medial-lateral and anterior-posterior positioning within the femoral head, however, did not appear to correlate. The Ender technique seems to be reasonably effective both for the treatment of stable intertrochanteric fractures and, if a good reduction and four or more nails are used, for the treatment of four-part unstable fractures. We do not recommend the technique for fractures with a subtrochanteric component unless mobilization of the patient can be delayed.