Studies on Ender's intramedullary nailing for closed tibial shaft fractures

Low cost multiple flexible Ender's nails can be used in tibial shaft fractures in a non-ideal operating room set-up in India, also because of easy methodology. It is commonly used in femur and humerus but not in tibia. So we made the study in which prospective and consecutive patients were taken based on selection criteria. Forty patients were treated by the technique from August 2004 to May 2006. Twenty-seven patients (67.5%) were male, 28 patients (70%) had fracture type 4-2A of AO classification, 37 patients (92.5%) had acute injuries, delay in surgery by 1-2 weeks in 21 patients (52.5%), 30 patients (75%) had closed nailing, 35 patients (87.5%) needed 2 nails, 36 patients (90%) were operated by antegrade nailing approach and 23 patients (57.5%) had fracture union within 16 weeks. All the patients were evaluated based on pain,range of movement of knee and ankle,shortening and radiological union along with ability to perform daily activities like squatting,sitting cross-legged and the ability to walk. There was excellent result in 34 patients (85%), good in 5 patients (12.5%), fair/poor result in 1 patient (2.5%). The complications observed were soft tissue irritation of the proximal part of tibia due to protruding nail in 5 patients,infection at the entry portal in one patient and non-union in one patient. Ender's nailing can be a safe and alternative method of fixation of fracture shaft of tibia in rural India for poor patients in 'not well set-up'.