ENDER NAIL: IS THE OLD IMPLANT EFFECTIVE TODAY?

Background – Tibial shaft fractures are the most common among long bone fractures. Except for the fractures with minimal displacement, treatment of these fractures is always surgical. Currently, locked medullary nailing is the preferred surgical treatment. However, use of these implants necessitates a set of instruments and specific facilities which are not currently accessible in many centers in Iran. Considering the successful results of Ender nailing in the last 20 years reported in literature and the fact that Ender nailing can be performed with simpler instruments and limited facilities in Iran, we studied the results of treatment by this method. Methods – From March 1999 to June 2001, 71 patients with tibial shaft fractures (53 males and 3 females) were treated by Ender nailing at Sina Hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran. We applied 2 to 3 Ender nails 4 to 4.5 mm in diameter. These nails were inserted in the medulla after making 2 small incisions near the tibial tuberosity in lateral and medial sides. Using descriptive statistics, we showed the satisfactory results of this set of operations. Results – Twenty-two (39.3%) fractures were closed and 34 (60.9%) were open. Of the 56 patients, 55 (98.2%) achieved union 8 (mean: 4.7) months after the operation. In 46 (82.1%), the fracture united in a maximum of 5 months and in 9 (16.1%), between 5 to 8 months. The most common complication was soft tissue irritation at the proximal tibia due to protruding Ender nails. Seven (12.6%) patients were affected with this problem and the nails were removed in 5 of them. Conclusion – If used correctly, Ender nail can be an effective tool in treatment of tibial shaft fractures especially in centers with lower access to sophisticated and expensive facilities.