A randomized, prospective study comparing Ender nailing with external
fixation for open fractures of sixty-three tibiae (sixty patients) was
undertaken. Ender nailing proved to be at least as effective as external
fixation with respect to seven parameters: time to union, tibial alignment,
total number of operations, ranges of motion of the knee and ankle, pain,
presence of infection, and complications. Ender nailing is a safe
alternative to external fixation for grade-I and grade-II open fractures.
It should not be used for comminuted fractures, which might shorten about
the nails.