Ender's method of intramedullary fixation of intertrochanteric and
subtrochanteric fractures is described. Ender's nail is a pre-bent flexible
steel nail with a diameter of 4.5 millimeters. Three to five of these nails
are inserted from a small incision proximal to the medial epicondyle of the
femur into the medullary canal. They are passed through the femur across
the fracture site and into the head of the femur, where they diverage. They
are in the lines of force and therefore are not subjected to bending
moments. The fracture fixation allows immediate weight-bearing. This method
of fixation was used in a series of 203 patients. Their average age was
sixty-eight years; the mortality rate was 10.3 per cent. In 3.9 per cent
superficial infections occurred, but in no case was there a deep infection
involving the bone. Functional return (walking) was achieved in all of the
survivors who were able to walk at the time of injury, and there were no
nonunions.