Between 1980 and 1984, a study to assess the usefulness of Ender nail fixation in the treatment of fractures of the proximal femur was conducted at the University of Tennessee Memorial Hospital. Data were recorded regarding shortening, malunion, knee pain, loss of reduction, nonunion, and pin problems. Assessment of operative time, blood loss, length of hospital stay, auxiliary fixation, and other parameters was made. This study, the first to utilize data from a large (225 cases), consecutive series of flexible nailings done by a small number of surgeons (the three authors), clearly demonstrated the advantages of Ender nailing in peritrochanteric fractures: fracture stability, decreased operative trauma, very low infection rate, and very low nonunion rate. The complication rate decreased significantly as the surgeons gained more expertise, emphasizing the importance of precision and experience in placing the Ender nails.
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