Treatment of open tibial fractures with Ender rods

In a retrospective, nonrandomized study from 1980 until 1988, 43 patients with 46 open tibial fractures were treated with Ender rods. The configuration of each fracture was classified using the Orthopaedic Trauma Association's (OTA) tibial fracture guidelines, and the extent of soft-tissue damage was graded using the Gustilo classification of open fractures. The OTA classification was further divided into stable, unstable, and highly unstable fracture configurations. Ender rods were placed immediately into 90% of fractures; and within one week of initial injury in the remainder. Follow-up evaluation of four patients (six fractures) could not be completed. The average time to union was 22.1 weeks, and there was a low incidence of complications. Otherwise there was a 40% incidence associated with early rod removal. Most complications occurred in those fractures that had extensive soft-tissue damage, and minimal or no inherent axial stability (unstable and highly unstable OTA classes). Except for the above-noted complications, Ender rods provide effective fixation for open tibial fractures with some degree of axial and rotational stability. In fractures with minimal or no inherent axial stability (OTA Classes IIIC, D; IVA, B), and in Grade IIIB or IIIC open tibial fractures, Ender rods have a higher incidence of complications and should be used with caution.