Of 100 patients with a peritrochanteric fracture of the femur treated by
the Ender technique, we reviewed the cases of seventy-nine after an average
follow-up of 11.4 months in order to clarify the indications for the
procedure and investigate variables that may affect the results. The
variables that correlated with the failure rate appeared to be the quality
of the reduction, the number of nails used, the experience of the surgeon
with the technique, and the degree of fracture instability. Nail placement
in terms of medial-lateral and anterior-posterior positioning within the
femoral head, however, did not appear to correlate. The Ender technique
seems to be reasonably effective both for the treatment of stable
intertrochanteric fractures and, if a good reduction and four or more nails
are used, for the treatment of four-part unstable fractures. We do not
recommend the technique for fractures with a subtrochanteric component
unless mobilization of the patient can be delayed.