[Ender nailing of subcapital fractures of the femur neck (Garden I)].

In the period between 1968 and 1982 we observed 441 subcapital fractures of the femoral neck, 55 times a tight impaction in valgus position. Including the year 1976 a conservative treatment was employed (group I); from 1977 onwards operations with the Ender-nailing technique were performed (group II). The patients' average age was 81 to 84 years. In 7 out of 32 cases the conservative functional treatment led to disimpacted fractures between the 5th and 54th day after the accident. Neither a slightly gaping fracture line nor an up to ten-degree antecurvatoral position are a radiologic-morphological criterion for a prognostic assessment. For that reason we performed the Ender-nailing operation in 23 cases from 1977 on. Under immediate postoperative and complete load it was only once we obtained a partial dislocation of fracture which had a compact osseous healing up in varus deformity. A cranial displacement of the nails caused by the operation was observed three times. All patients regained their ability to walk. Until the end of the first year of the accident there was no case of death, nor could we perceive any total necrosis of the femoral head. One pseudarthrosis was found after conservative treatment. The average clinical treatment was 42 respectively 21 days. We transferred 19 out of 32 respectively 7 out of 23 patients to a convalescent hospital. The impacted subcapital fracture of the femoral neck should nowadays be treated operatively. The Ender-nailing technique represents a simple, gentle, and a low-risk procedure for surgical stabilization.