Ender Nailing with Distal Wiring Technique in the Treatment of Intertrochanteric Femoral Fracture

Cho, Duck Yun; Lee, Joong Myung; Kim, Kyu Hwan

Abstract

In the treatment of elderly hip fracture, early mobilization as a means of reducing early postoperative morbiyt and morbidity is mandatory. Even though Ender nailing have many advantages, most serious problems with use of Ender nailing method are distal migration of nails, subsequent loss of fixation and limited knee joint motion. To prevent these difficult problems, we have used distal wiring technique with Ender nailing since 1988. In operation, we performed Ender nailing as usual manner under image intensifier and for the prevention of the nail migration, we performed circumferential wiring through the each Ender nail eye and above the adducter tubercle of the distal femur. Forty six cases were available with minimum follow-up of six months which were healed radiologically and clinically (Mean follow up: 21 months). The mean age was 74 years (Range: 52 years-88 years)and showed 26 cases of famale and 20 cases of male. The radiological morphometry using Singh index showed poor bone quality: 36 cases were below Grade III and the fracture type was classified by Tronzo criteria. In results, patients who had Ender nailing with distal wiring showed no distal migration, however one case of proximal migration was observed at the beginning stage of this technique. So, in elderly trochanteric fracture, to reduce the complication of the Ender nailing, especially nail migration, the authors recommend the Ender Nailing with distal wiring technique.