Journal of Musculoskeletal Trauma

Ender Nailing of Tibial Shaft Fractures: In Young Ok, Yang Guk Chung, Tec Soo Kim; J Korean Soc Fract 2000;13(1):87-95. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.87

PURPOSE
Though Ender nailing in tibial shaft fractures is a good method of treatment, there were several reports about complications such as angulation or shortening. Most of those complications were associated with improper surgical technique and might be avoidable. So, we analyzed the results of tibial Ender nailing in view of the complications and their contributing factors. MATERIAL AND METHOD: Thirty-five tibial shaft fractures were treated with Ender nailing and followed up for 12 to 51 months. We evaluated the bony union, angulation, shortening, proximal migration of nail and infection, and analyzed the results in association with the type and the location of fractures, the number and the length of nails and the divergency of distal tip of nails.
RESULTS
Average bony union time was 18.5 weeks and there were 2 delayed unions, 2 nonunions, 5 angulations, 1 shortening, 3 soft tissue irritations by proximal tips of nails, 1 proximal migrations of nails and one nail breakage. Most of them were associated with technical faults such as few number, short length or insufficient divergency of nails. According to the type of fractures, the highest rate of complications was seen in segmental fractures.
CONCLUSION
Performed by proper surgical technique based on detailed fracture analysis, most of the complications of Ender nailing for tibial shaft fractures might be avoidable. Therefore, Ender nailing is one of the useful alternatives for tibial shaft fractures.

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Manoeuvring Distal Tibial Shaft Fractures with Ender’s Nailing: Case Series
Aditya Pundkar, Chandrashekar Kulkarni
Journal of Datta Meghe Institute of Medical Sciences University.2023; 18(3): 481. CrossRef

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Treatment of Two-part, Displaced Surgical Neck Fracture of the Proximal Humerus with Modified Ender Nail and Tension Band Technique: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):395-401. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.395

Abstract PDF

Operative treatment of two-part, displaced surgical neck fractures of the proximal humerus is used when satisfactory closed reduction cannot be achieved or maintained. Recently, we modified the Ender nails by making an additional hole above the slot for wire incorporation. The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing and tension band technique. We reviewed the data of fourteen consecutive patients (10 women and 4 men) who had been treated with Ender nailing and tension band wiring between from Aug 1996 and Oct 1997 at Eulji Medical College Hospital. The average age of patients was 54 years (range, 38 to 79 years), and the average follow-up period was 18 months (range, 12 to 24 months). Bone union was observed at 6.3 weeks (range, 5.5 to 10 weeks), except one case of delayed union. There were no infections and nonunions. The average ranges of shoulder elevation and abduction were 140 degrees(100 degrees to 170 degrees) and 126 degrees(100 degrees to 160 degrees), respectively. The median value of the thumb to vertebral distance was L1, with a range of T6 to L5 for internal rotation, external rotation was 48 degrees (30 degrees to 70 degrees) . Radiography revealed one case of medial shift greater than 5mm, and 4 cases of lateral shift greater than 5mm of the humeral shaft. The average varus angulation of the humeral neck was 8.5o(0 degree to 34 degrees). Four patients (28.6%) were excellent (34 to 35), six patients (42.8%) were good (28 to 33), four patients (28.6%) were fair (21 to 27) in UCLA shoulder rating scale. In conclusion, Ender nailing and incorporation of the tension band wire loops provided additionally rotational and longitudinal stability in two-part displaced surgical neck fracture of the proximal humerus associated with osteoporosis.

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis
Soo-Tai Chung, Joo-Hak Kim, Hyung-Soo Kim, Sang-Joon Park
Journal of the Korean Fracture Society.2007; 20(2): 184. CrossRef

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Ender Nailing for Femoral Shaft Fracture in Children: Won Sik Choy, Cheun Hwan Yoo, Sang Suk Ong; J Korean Soc Fract 1997;10(1):180-187. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.180

Abstract PDF: The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding Children with multiple systemic injury, a head injury, and/or with multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a frac- ture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional(traction/casting) methods of fracture management. Here closed intramedullary Ender nailing of 15 femoral fractures in 15 children, 7-13 years of age, was studied retrospectively. Seven patients had associated injuries. The average operation time was 40 minutes and hospitalization time averaged 16 days. There were no infections, nonunions, or malunions. On follow-up, average 27 months, no patient had deformity of over 8 degree in any plane. No patient had clinical loss of motion, leg length discrepancy, or radiographic evidence of growth disturbance. Here, authors Concluded that closed Ender nailing is very useful method in the management of femoral shaft fracture in children over 10 years old or when there is associated head injury or multiple fractures regardless of patients age.

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A Comparison of the Using of Plate fixation and Ender nailing in Humeral Shaft Fractures: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Eim, Soo Dong Baek; J Korean Soc Fract 1996;9(1):161-169. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.161

Abstract PDF: The humerus is anatomically and physiologically unique bone: firstly, it is a non-weight bearing bone; secondly, it has greatest range of motion; thirdly, while the person is standing, the axis of bone hangs vertically and is influenced by gravity, and conservative methods are usually used in treatment. However. in the cases of closed reduction failure, open fracture, multiple fracture, and old age etc, operative methods may be employed. This decision should be based on the type, location of fracture. the presence of concomittent injuries, the age, and the general condition of the patient. When open reduction and internal fixation is carried out, the periosteum and soft tissue attachment is stripped off and operative time is longer Flexible Ender nailing is a simple procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, and decreases the chance of infection and allows early exercise. Authors carried out fixation in 28 patients and Ender nailing in 24 patients having humeral shaft fractures who were treated at the orthopedic department, Hae Dong hospital from March, 1990 to February, 1994.

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Overall Review of the Treatment of Tibial Fracture by Endernailing: Technical Consideration of Ender Nailing on Tibial Fracture: Hyung Ku Yoon, Kwang Pyo Jeon, Dae Eun Jung, Ho Seung Jeon, Dae Young Jaang; J Korean Soc Fract 1995;8(2):370-377. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.370

Abstract PDF: Fractures of the tibia are one of the most common injury encountered by orthopaedic surgeons and their treatments are considered to be difficult due to serious complications. Many treatment modalities were introduced. Among them, Ender nailing is considered one of the useful modality because it is a relatively simple and, 3ess invasive procedure Authors analized 123 tibial fractures treated with Endr nails from Feb. 1986 to Feb. 1992 to solve the problems during Ender nailing. The follow up ranged from 12months to 51 months with an average of 11 months. The results are as follows; 1. Among 123 patients,93 cases are male and 30 cases are female. Traffic accident is the most common cause of injury. 2. Average interval from injury to operation is 9 days and average 2.1 Ender nails are used. The mean duration of the bone union is 19.1 weeks. 3. To prevent knee joint pain, more distal medial and lateral portal of entry and more posteriorly located lateral portal of entry were used. 4. To provide stability of distal 1/3 fracture,3 or more nails are introduced with fanning in AP and lateral plane. 5. to provide stability of the comminuted fractures, convexities of at least 2 nails are located at the comminuted site. 6. To prevent rotation of the middle fragments of segmental fractures, technique of temporary Steinmann pin fixation for handling the middle fragment during operation were used.

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Clinical Study of Nonunion of Clavicle in Adult: Dae Yong Han, Ik Hwan Yang, Jo Hyung Lee; J Korean Soc Fract 1992;5(2):356-364. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.356

Abstract PDF

Although the clavicle is one of the most commonly fractured bone, nonunion is rare. The authors experienced 15 cases of clavicle nonunion in adult who were admitted and treated at the Department of Orthopedic Surgery of Severance Hospital during period from January 1983 to December 1990 (eight years). This study focused on the predisposing factors in relation to nonunion of clavicle and the analysis of the results after operative treatment The results of analysis wire as follows ; 1. Predisposing factors of nonunion were primary operative treatment with inadequate fixation, middle 1/3 of clavicle, severe associated injury and initial gross displacement of fracture fragment. 2. Among the 15 patients, 14 patients were treated with plate and screw fixation and autogenous iliac bone graft. One patient was treated by metal removal due to infected nonunion. 3. Using a rating scale of excellent(no apparent fractors), good(one factor), fair(two factors), poor(more than three factors), the result showed, 12 excellent, 1 good, and 2 poor 4. Amonf the is opeTative treatment, there was only one case of complication which was metal failure. It was concluded that symptomatic nonunion of the clavicle could be treated by operation. and the procedure of choice seemed to be rigid internal fixation with plate and bone graft.

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Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Jung-Ho Kang, Kwang-Hee Park
Journal of the Korean Fracture Society.2007; 20(3): 233. CrossRef

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Treatment for Two-part Fracture of the Humerus Surgieal Neck by Ender Nailing: Choong Gil Lee, Jin Woo Kwon, Soo Yong Kim, Kyung Tae Son; J Korean Soc Fract 1992;5(2):348-355. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.348

Abstract PDF: There is no consensus on the best way to treat complicated fractures of the proximal humerus. We treated two-part surgical neck fractures which were not suitable for conservative method by semi-open reduction and Ender nailing with addition of cancellous bone graft. This method provided good three-point fixation and then early ROM exercise was possible even in case of osteoporotic or severely comminuted surgical neck fractures. Between June 1989 and February 1992, Ender nailinss were performed for two-part surgical neck fractures, and among those cases 16 were followed for more than 1 year. The results of study were as follows ; 1. All cases were treated by seml-open reduction and Ender nailing with additional cancelous bone graft. 2. Ender nails were inserted through retrograde entry in all cases. 3. Complications developed in 3 cases ; one case of proximal migration of Ender nail and two of shooter joint partlal stiffness. 4. The mean duration of radiologic bone union was postoperative 9 weeks. 5. According to Neer criteria 11 cases were good, 3 fair and 2 poor results.

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Treatment of Intertrochanterie fracture of the Femur with Ender Nails in the Elderly Patients: Seong Taek Kim, Ki Soo Kim, Yeub Kim, Seung Hee Koh, Yong Soo Choi, Sang Tae Park; J Korean Soc Fract 1992;5(2):300-308. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.300

Abstract PDF: The incidence of intertrochanteric fracture of the femur in the elderly patient has been increased progresslvely due to the prolongation of Korean average life span and improvement of the medical survice. The mortality. however, in these elderly patients is relatively high. Rigid internal fixation of intertrochanteric fracture with early mobilization of the patient has in recent years reduced the mortality and morbidity. From September 1984 to August 1991, the authors had treated with Ender nails for 126 cases of intertrochanteric fracture. From 109 cases followed more than six months, the clincal results were as follows. 1. The average age was 74.8 years. 2. 73 cases (67%) were unstable fractures and 36 cases (33%) were stable fractures by Evans classification. The most common type was type 3 (35.8%) by the Tronzo classification, A2 type(55.1%) by the AO classification. 3. The main indication were stable fracture, unstable fracture over 70 years old, high anesthe tic resk, severe osteoporosis and wound at greater trochanter. 4. Intraoperatlve complications were experienced in 37 cases(33.9%). The improper entry hole site was most common. 5. Postoperative complications occured in 57 cases(52.3%) and more frequently in unstable fractures(57.5%). The most common complication was knee joint pain in 45 cases (41.3%) 6. Recently, patients who had Ender nails with Knowles pins showed good results in the presence of severe osteoporosis or unstable fracture.

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The Treatment of Type III Open Tibia Fractures with Ender Nails: Preliminary Report: Sang Ho Ha, Sang Hong Lee, Dong Min Shin, Jin Seok Park; J Korean Soc Fract 1989;2(2):219-228. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.219

Abstract PDF: Type III open tibial fracture is difficult to treat beacause of frequent complications, and recently external fixation have been used successfully. Intramedullary nailing with flexible nails is now routinely performed in Type I and II open tibial fractures. Thirteen cases of Type III open tibial fractures teated with Ender nails from January 1 983 to December 1988 were identified and retrospectively reviewed. The results were as follows; 1. The patients were predominantly more common in male and the average age was 41 years, and most common cause was traffic accident. 2. According to the Gustilo and Andersons classification, Type III-A was 7 cases, TypeIII-B was 5 cases, and Type III-C was 1 case. All 13 cases were combined fibular fracture. 3. All 13 cases were used two Ender nails, nailing methods were two antegrade insertioni (7 cases), two retrograde insertion (3 cases), and one antegrade & retrograde insertion (3 cases). 8 cases were operated within one day of accident, 7 cases were used other combined metals, and 5 cases were treated with Rush pinning of fibular fracture. 4. Among the secondary additional operation required after Ender nailing, bone operation were 7 cases, soft tissue operation were 5 cases, and delayed amputation were 2 cases. 5. Among II cases except amputation, controversial complications were nonunion (6 cases), chronic osteomyelitis (1 case), delayed union (1 case). 6. A retrospective evaluation of 13 cases treated Ender nailing revealed that Ender nailing was simple, effective method in some selected cases of Type III open tibia fractures.

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