Ender nailing of pertrochanteric fractures. Complications related to technical failures and bone quality

In a series of 127 consecutive patients with trochanteric femoral fractures treated with Ender nailing, bone quality and technical failures were analysed. Of the fractures, 35 per cent were stable and 65 per cent unstable according to the definitions of Evans. There were no implant failures. Technical failures occurred in 16 cases. These could be referred to unsuitable location of the nails in the femoral head and/or to an insufficient fixation of the nails in the medullary cavity, especially in patients with poor bone quality and unstable fractures. Technical failures should therefore be preventable. When a correct surgical technique is used with a sufficient number of nails in femurs with low bone quality and a wide medullary canal, the method seems to be a simple and safe treatment for most pertrochanteric fractures, with elimination of many of the problems often associated with this injury.