Journal of Musculoskeletal Trauma

Ulnar Insufficiency Fractures in Patients on Prolonged Bisphosphonate Therapy: A Case Report: Kyu Min Kong, Yong Uk Kwon, Young Kyung Min, Doo Yeol Kim; J Korean Fract Soc 2019;32(3):143-147. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.143

Atypical fractures associated with prolonged bisphosphonate (BP) therapy rarely occur outside the femur, and the diagnostic criteria, appropriate treatment principles, and fixation methods for atypical ulnar fractures have not been established. The authors experienced the use of internal fixation with a metal plate and a new internal fixation method with an intramedullary nail in the treatment of an atypical ulnar fracture in a patient who had been on BP therapy for 10 to 20 years. This paper reports findings along with a review of the relevant literature.

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Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy: A Case Report
Dong-Soo Kim, Ji-Kang Park, Eui-Sung Choi, Ho-Seung Jeong, Seok-Hyun Hong, Byung-Hyun Ahn
Journal of the Korean Fracture Society.2020; 33(2): 101. CrossRef

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Ender Nailing of the Tibial Shaft Fractures under the Local Anesthesia: Sang Ho Ha, Jun Young Lee, Deog Yong Kim; J Korean Fract Soc 2006;19(2):147-152. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.147

Abstract: PURPOSE
To evaluate the clinical result of ender nailing under local anesthesis was done to patient with tibia shaft fracture who had high risk for general anesthesia or spinal anesthesia.
MATERIALS AND METHODS
10 cases with ender nailing procedure under local anesthesia due to high anesthetic risk were selected from total of 20 cases with tibia shaft fracture operated with ender nailing. In each patient, hepatic, diabetic, cadiopulmonary complication and thromboembolism which can be initiated or aggravated by general or spinal anesthesia, were evaluated. Radiologic and clinical evaluation were used to check bone union.
RESULTS
There were no complication of local anesthesia. Bone union were acquired in all cases with average bone union period of 18 weeks. There were no evidence of flexion deformity, limb shortening or joint contracture.
CONCLUSION
Ender nail fixations under local anesthesia enable close reduction and intramedullary nailing and is effective in patient care but has no problem with bone union. For this reason, ender nail fixation under local anesthesia seem to be effective method if general of spinal anesthesia is difficult.

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Modified Ender Nailing For Intertrochanteric Fracture of the Femur: Jin Wan Kim, Jeong Hoi Goo, Hyung Lae Cho, Young Chul Ko, Young Il Park, Seong Hwak Hong, Man Jun Park, Jang Seok Choi; J Korean Fract Soc 2005;18(4):379-384. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.379

Abstract PDF: PURPOSE
To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients.
MATERIALS AND METHODS
31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union.
RESULTS
22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively.
CONCLUSION
The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.

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Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia: Ju yong Shin, Duk Hwan Kho, Dong Ok Kim, Dong Heon Kim; J Korean Fract Soc 2004;17(2):202-207. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.202

Abstract PDF: PURPOSE
To evaluate the usefulness of IM Ender nail in treating femoral intertrochanteric fractures with high risks including cardiovascular disease, pulmonary disease, liver cirrhosis, cerebrovascular disease, metastatic cancer, and skin problem at hip joint region.
MATERIALS AND METHODS
Thirty-five patients of pre-existing diseases and femoral intertrochanteric fractures treated with Ender nailing, January 1990 to November 1997. Under the c-arm guided, closed reduction and internal fixation were performed using Ender nails, We analized operation time, blood loss, bone union, ambulation time and complications RESULTS: Mean operation time was 55 minutes, mean blood loss was 120 ml, mean radiological bone union was 12 weeks and average of partial weight bearing was 6.9 days. Postoperative complications were gastrointestinal discomfort in 3 cases, superficial wound infection in 1 case, knee pain in 7 cases, inguinal pains in 5 cases, distal migration of nails in 3 cases, varus deformity in 2 cases, proximal migration of nail with nonunion in 1 case.
CONCLUSION
The intramedullary ender nail is useful method in treating femoral intertrochanteric fractures in high risk patients of anesthesia and blood loss or skin problem at hip joint region.

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Treatment of Large Bone Defect of Femorl Shaft with Vascularized Fibular Graft and Ender Nail: A Case Report: Song Lee, Dong Ki Ahn, Sung Wook Chun, Sun Young Chung, Hyun Soo Kim; J Korean Soc Fract 2003;16(3):340-347. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.340

Abstract PDF: Vascularized fibular graft is one of the well accepted methods in the treatment of large bone defect of femoral shaft. But bone fixation with Ender nails through the same incision of bone graft has never been reported. We performed vascularized fibular graft and bone fixation with Ender nails through single medial skin incision and permitted physiologic stress. We achieved early radiologic union and medullary widening and the patient could return to work 9 months after the accident. We would like to report such an experience of treatment with the reference of literature.

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Comparison between Ender Nail and Interlocking Nail in The Treatment of Infra-isthmic Tibial Shaft Fracture: Seung Wook Yang, Moo Ho Song, Hyung Taek Park, Sun Jin Choi; J Korean Soc Fract 2001;14(4):651-659. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.651

Abstract PDF: PURPOSE
To compare the clinical results between Ender nail and interlocking nail in the treatment of infra-isthmic tibial shaft fracture.
MATERIALS AND METHODS
The authors analyzed 44 cases of infra-isthmic tibial shaft fracture treated with Ender nail(23 cases) as a group 1 or interlocking nail(21 cases) as a group 2 from 1994 to 1998. Fracture type was divided by AO classification, and measured the fracture level, the time of bone union and angular deformity was checked with roentgenograms. The functional results were compared using the criteria by Klemm and Borner.
RESULTS
Distal end of fracture line from ankle joint shows no difference between two groups(P>0.05). Mean operation time was 96 minutes in group 1 and 140 minutes in group 2(P<0.05). Mean intraoperative blood loss was 103cc in group 1 and 254cc in group 2(P<0.05). Mean bone union time was 19.26 weeks in group 1 and 24.81 weeks in group 2. There was no significant difference between two groups in the angulation(P>0.05) and the functional results by Klemm and Borner.
CONCLUSION
Ender nail is a good method of treatment in infra-isthmic tibial fracture when isthmic portion of tibia is too narrow, or insertion of distal interlocking screws were too difficult to insert because of the severe soft tissue injury. The stability of fixation can be strengthened with a three point fixation as fanning of the nails in the distal fragments using more than 3 nails selecting a 1cm longer nail than the ordinary nail length for diaphyseal fracture.

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Two stage Operative Treatment of Supracondylar Open Comminuted Fracture of Femur: Temporary fixation with Transarticular Ender nails: Song Lee, Dong Ki Ahn, Seung Hwan Kim, Sung Wook Chun; J Korean Soc Fract 2000;13(3):470-478. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.470

Abstract PDF: PURPOSE
In many cases of open comminuted supracondylar fracture, it is very hard to apply traditional methods. So we have used Ender nails for temporary transarticular fixation. We thought that it could provide enough stability to control the wound and didn't promote further soft tissue damage or infection. We performed 2nd stage rigid fixation and bone graft after soft tissue healing. We have studied to prove this staged operation valuable to treat the very severe open comminuted supracondylar fracture of femur.
MATERIALS AND METHODS
We analysed 16 cases which have been treated with such staged operation method from April 1992 to April 1996 about complication, union time and functional result in retrospective method.
RESULTS
We could prevent severe wound infection in all cases. We performed 2nd stage rigid fixation and bone graft average 6 weeks after first stage temporary fixation. The average union time was 8 months and average range of motion was 10degrees flexion contracture and 100degrees further flexion.
CONCLUSION
In patients with very severe open comminuted supracondylar fracture of femur, the temporary fixation with transarticular Ender nails allowed the successful initial management for the secondary rigid fixation and bone graft and time could be saved for management of concomitant injuries. So this new staged operation is considered as a good method for safety, union time and functional result.

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Femoral Trochanteric Fracture Treated with Ender Nails in Elderly Patients: Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yeon Sik Yu, Eui Sang Seil; J Korean Soc Fract 2000;13(2):343-351. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.343

Abstract PDF: PURPOSE
: To analyze the clinical and radiological result of femoral trochanteric fractures treated by using Ender nails in elderly patients. MATERIAL AND METHODS :Sixty seven patients of femoral trochanteric fractures treated at Korean Veterans Hospital from 1993 to 1997 were included in this study. Under the C-arm guided, closed reduction and internal fixation with Ender nails was done within one week. According to Kyle classification, we classfied type I in 12case, type II in 20cases, type III in 25cases, typeIV in 20 cases and analyzed duration of bone union, ambulatory ability and postoperative complication.
RESULT
: The duration of union was from 14 weeks to 17 weeks and the mean was about 15.5 weeks. Thirty seven(60.7%) patients maintained their prefracture ambulatory ability at a postoperative 1 year and twenty four(39.3%) patient lost some degree of ambulatory ability. Postoperative complications were the knee pain and the limitation of the motion of the knee in 10 cases(14.9%), external rotation deformity in 7 cases(10.4%), distal migration of nails in 4 cases(5.9%), proximal migration of nails in 2 cases(2.(%), nonunion in 2 cases(2.9%).
CONCLUSION
: We conclude that the treatment by using Ender nails is one of the proper methods in elderly femoral trochanteric fracture with associated medical complication.

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Ender Nailing of Tibial Shaft Fractures: In Young Ok, Yang Guk Chung, Tec Soo Kim; J Korean Soc Fract 2000;13(1):87-95. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.87

Abstract PDF

PURPOSE
Though Ender nailing in tibial shaft fractures is a good method of treatment, there were several reports about complications such as angulation or shortening. Most of those complications were associated with improper surgical technique and might be avoidable. So, we analyzed the results of tibial Ender nailing in view of the complications and their contributing factors. MATERIAL AND METHOD: Thirty-five tibial shaft fractures were treated with Ender nailing and followed up for 12 to 51 months. We evaluated the bony union, angulation, shortening, proximal migration of nail and infection, and analyzed the results in association with the type and the location of fractures, the number and the length of nails and the divergency of distal tip of nails.
RESULTS
Average bony union time was 18.5 weeks and there were 2 delayed unions, 2 nonunions, 5 angulations, 1 shortening, 3 soft tissue irritations by proximal tips of nails, 1 proximal migrations of nails and one nail breakage. Most of them were associated with technical faults such as few number, short length or insufficient divergency of nails. According to the type of fractures, the highest rate of complications was seen in segmental fractures.
CONCLUSION
Performed by proper surgical technique based on detailed fracture analysis, most of the complications of Ender nailing for tibial shaft fractures might be avoidable. Therefore, Ender nailing is one of the useful alternatives for tibial shaft fractures.

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Manoeuvring Distal Tibial Shaft Fractures with Ender’s Nailing: Case Series
Aditya Pundkar, Chandrashekar Kulkarni
Journal of Datta Meghe Institute of Medical Sciences University.2023; 18(3): 481. CrossRef

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Leg Length Discrepancy after Ender Nail Fixation in Children Femoral Shaft Fracture: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Jin Ho Park; J Korean Soc Fract 2000;13(1):172-177. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.172

Abstract PDF: PURPOSE
: The purpose of this study is to evaluate the seg length discrepancy after Ender nail fixation in children's femoral shaft fracture.
MATERIALS AND METHODS
: We reviewed 18 femoral shaft fracture that were treated with Ender nail and studied the relationship between the initial site of fracture, type of fracture and overgrowth. The age of children in this study ranged 6 to 13 years old and the average period of follow-up was 32 months.
RESULTS
: The range of leg length discrepancy was from 6 mm shortening to 16mm lengthening and average 3.4 mm lengthening. Only one patient had shortening, nine patients had limbs of equal length(less than 2 mm) and eight patients had lengthening. The average overgrowth was 1.3 mm in proximal 1/3, 7.0 mm in middle 1/3, 3.0 mm in distal 3/1 fractures. The average overgrowth was 7.3 mm in transverse, 1.3 mm in oblique and 2.3 mm in comminuted fractures.
Conclusions
: We consider closed Ender nailing in children femoral shaft fractures as a good treatment modality in the matter of leg length discrepancy.

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The Results of Surgical Treatment of Intertrochanteric Fractures in the Elderly Patients Aged over 65 years : Comparative Study between Compression Hip Screw and Ender Nail Fixationt: Byeong Yeon Seong, Chang Min Lee, Dong Sung Park; J Korean Soc Fract 1999;12(4):802-811. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.802

Abstract PDF: OBJECTIVES
: To analyse the comparative results of surgical treatment with compressive hip screw or Ender nail for intertrochanteric fracture in aged over 65 years. MATERIALS & METHODS : From June 1990 to December 1997, 39 of 55 patients who were operated with compression hip screw or Ender nailing and followed up for more than 1 year. A retrospective survey was completed for 39 intertrochanteric fractures which were operated with compressive hip screw(22 patients, Group 1) or Ender nail(17 patients, Group 2). There was an average follow up of 48 months, with a range of 12 to 84 months. Radiographic measurements were performed in aspects of osteoporosis and fracture classification. Clinical evaluation of follow up was measured as Clawsons evaluation according to the fracture claffification and types of fixation. 23 of 39 cases(59%) were unstable and 26 of 39 cases(66.6%) showed below grade III in osteoporosis. Age, cause of fracture, fracture classification, accompanying diseases and Singhs index were identical to both group.
RESULTS
The mean radiologic bone union period was 16.4 weeks. The rate of complication was 7 cases(31.8%) in group I and 8 cases(47.0%) in group II. The rate of mortality was 3 cases(13.6%) in group I and 3 cases(17.6%) in group II. Satisfactory rate was 20 of 22cases(90.9%) in group I and 14 of 17 cases(82.3%) in group II.
CONCLUSION
: We suppose that compressive hip screw fixation for the elderly over 65 years who had intertrochanteric fracture and medical problem, produced good results as comparing to Ender nail fixation. The clinical satisfactory rate were superior in the compressive hip screw group comparing to Ender nail group. Cement fixation for eldly could help to fixate more in compression hip screw.

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Treatment of conuninuted Segmental Fracture of the Proximal Tibial Shaft with Retrograde Ender Nails: Jung Geun Choi, Geun Sun Choi, Soo Jae Yim, Syung Ryul Yoon; J Korean Soc Fract 1999;12(3):543-548. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.543

Abstract PDF: PURPOSE
To present the result of retrograde Ender pinning technique for treatment of comminuted segmental fracture of the proximal tibial shaft.
MATERIALS and METHODS
From 1994 to 1998, we treated twenty-one cases of the comminuted segmental proximal tibial shaft fracture with the retrograde Ender pinning technique. We have followed up the clinical results.
RESULTS
The clinical bone union time was average eleven weeks, and the radiologic bone union time was average nineteen weeks.
CONCLUSIONS
In the treatment of comminuted segmental proximal tibial shaft fracture, the retrograde Ender pinning technique is useful. The method improves fixation of the proximal fragment, is simple and effective, provides good fixation of the tibia in patients in whom stabilization of several fractures is required, and can be used for fixation of tibial shaft fracture with soft tissue damage.

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Treatment of Two-part, Displaced Surgical Neck Fracture of the Proximal Humerus with Modified Ender Nail and Tension Band Technique: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):395-401. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.395

Abstract PDF

Operative treatment of two-part, displaced surgical neck fractures of the proximal humerus is used when satisfactory closed reduction cannot be achieved or maintained. Recently, we modified the Ender nails by making an additional hole above the slot for wire incorporation. The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing and tension band technique. We reviewed the data of fourteen consecutive patients (10 women and 4 men) who had been treated with Ender nailing and tension band wiring between from Aug 1996 and Oct 1997 at Eulji Medical College Hospital. The average age of patients was 54 years (range, 38 to 79 years), and the average follow-up period was 18 months (range, 12 to 24 months). Bone union was observed at 6.3 weeks (range, 5.5 to 10 weeks), except one case of delayed union. There were no infections and nonunions. The average ranges of shoulder elevation and abduction were 140 degrees(100 degrees to 170 degrees) and 126 degrees(100 degrees to 160 degrees), respectively. The median value of the thumb to vertebral distance was L1, with a range of T6 to L5 for internal rotation, external rotation was 48 degrees (30 degrees to 70 degrees) . Radiography revealed one case of medial shift greater than 5mm, and 4 cases of lateral shift greater than 5mm of the humeral shaft. The average varus angulation of the humeral neck was 8.5o(0 degree to 34 degrees). Four patients (28.6%) were excellent (34 to 35), six patients (42.8%) were good (28 to 33), four patients (28.6%) were fair (21 to 27) in UCLA shoulder rating scale. In conclusion, Ender nailing and incorporation of the tension band wire loops provided additionally rotational and longitudinal stability in two-part displaced surgical neck fracture of the proximal humerus associated with osteoporosis.

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis
Soo-Tai Chung, Joo-Hak Kim, Hyung-Soo Kim, Sang-Joon Park
Journal of the Korean Fracture Society.2007; 20(2): 184. CrossRef

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A comparison of fixation with Ender nail and sliding screw plate in intertrochanteric fractures of elderly patients: Joo Hyoun Song, Yong Koo Kang, Han Yong Lee, Hae Seok Koh, Kee Won Rhyu, Kwang Won Lee; J Korean Soc Fract 1999;12(2):203-211. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.203

Abstract PDF: In order to investigate the correlation between morbidity of the elderly patients and method of fixation, we analyzed 39 elderly patients had undergone internal fixation with Ender nail or sliding screw plate for the intertrochanteric fractures of the femur from January 1992 through December 1995. Among the 39 patients, 20 patients and 20 fractures were treated with Ender nail. Mean follow-up period was 26 months and average in age was 76.2 years Remaining 19 patients, 19 fractures were treated with sliding screw plate Mean follow-up period was 25 months and average in age was 75.4 years. The results obtained were as follows : 1. In the cases where Ender nails were used, the average operation time took in the average of 45 minutes and whereby, in the cases where sliding screw plates were used, took in the average of 110 minutes. 2. During the operation time, the amount of hemorrhage in the cases of Ender nail was about 100ml and the sliding screw plate resulted in about 350 ml. And the average amount of transfusion was 0.9 pints in cases of Ender nail and 2.3 pints in cases of sliding screw plate. 3. Among 20 patients fixed with Ender nail, only 2 patients had to be cared at ICU, but 9 of 19 patients had to be cared at ICU in the cases of sliding screw plates. 4. In the cases of Ender nail, the radiologic bony union time was about 13.4 weeks and they could walk with supports with in a week. But, in the cases of sliding screw plate the radiologic bony union time was about 16.2 weeks and they could walk with orthrosis at 28.4 days postoperatively. 5. Most patients treated with Ender nail were suffered from the problem at knee and protrusion of Ender nail into the hip joint, backing out of nail through the entry, coxa valga deformity were major complications after the operation. In the cases of sliding screw plates, loosening of sliding screw with coxa vara deformity, wound infection and delayed union were major complications. 6. Despite of many complications, if the indication is chosen well, the fixation with Ender nail will result in a benefical treatment method in the elderly patients for its advantages in general condition of the patients.

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Ender nailing For Intertrochanteric Fracture of the Femur in the Elderly patients: Hak Yeong Jeong, Seung Wook Yang, Seung Joon Shin, Hyeong Joon Seung; J Korean Soc Fract 1998;11(4):745-753. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.745

Abstract PDF: The principle of treatment of intertrochanteric fracture is early operation and early rehabilitation. The morbidity and mortality associated with intertrochanteric fracture are remained high because the elderly patient generally have a reduced tolerance for prolonged bed rest, lengthy operation and blood loss. Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fracture of the elderly patient, but it has been rarely used for unstable fracture. The authors analysed 87 cases of intertrochanteric fractures of femur over 60 years old, treated with Ender nailing during period from July, 1998 to October, 1996. The results were as follows : 1. Among 87 cases, 70 cases were female and average age was 75.3 years old. 2. The common complications were knee pain and LOM(10%) and distal migration of nails(3%). 3. These complications were reduced by careful bending of nails, fanning of nails in femoral head, stacking of medullary canal and accurate placement of portal hole. 4. 10 patients died within 1 year(Mortality rate : 11%). 5. Thirty-six(47%) patients maintained their prefracture ambulatory ability at a postoperative 1 year ; Fourty-one(53%) patients lost some degree of ambulatory ability. 6. In unstable intertrochanteric fracture, we can achieved good results by Ender nailing in valgus reduction.

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Treatment of Tibial Shaft Fractures with Ender Nailing and Postoperative Functional Bracing: Young Soo Byun, Hong Tae Kim, Won Ho Cho, Se Ang Chang, In Hak Choi, Jin Wook Jung; J Korean Soc Fract 1997;10(3):541-547. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.541

Abstract PDF: Ender nailing is an alternative method of treatment of selected unstable tibial shaft fractures. The purpose of this study is to evaluate the result of functional treatment with Ender nailing and postoperative functional bracing. We treated 31 tibial shaft fractures(16 closed, 15 open) with closed Ender nailing and postoperative functional bracing between August 1990 and September 1994 and followed up the patients from minimum 10 months to 74 months. Clinical analyses were as follows; 1. According to AO classification, 10 cases were Type A simple fractures(32%), 14 Type B wedge fractures(45%), and 7 Type C complex fractures(23%). 2. Ninety four percent of the fractures united in an average time of 17.3 weeks. The average time to union of complex fractures was longer than that of simple and wedge fractures(P<0.05). 3. There were two nonunions(6.5%), two delayed unions(6.5%), and three angulatory malunions(9.7%) between 6 and 10 , but there was no putient of significant shortening, joint stiffness, or infection. The Ender nails provide sufficient stability at the fracture site of the tibial shaft to permit carly weight-bearing in a functional brace, and this treatment provides early fracture union with less complicatioins and facilitates functional recovery.

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Ender Nailing for Femoral Shaft Fracture in Children: Won Sik Choy, Cheun Hwan Yoo, Sang Suk Ong; J Korean Soc Fract 1997;10(1):180-187. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.180

Abstract PDF: The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding Children with multiple systemic injury, a head injury, and/or with multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a frac- ture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional(traction/casting) methods of fracture management. Here closed intramedullary Ender nailing of 15 femoral fractures in 15 children, 7-13 years of age, was studied retrospectively. Seven patients had associated injuries. The average operation time was 40 minutes and hospitalization time averaged 16 days. There were no infections, nonunions, or malunions. On follow-up, average 27 months, no patient had deformity of over 8 degree in any plane. No patient had clinical loss of motion, leg length discrepancy, or radiographic evidence of growth disturbance. Here, authors Concluded that closed Ender nailing is very useful method in the management of femoral shaft fracture in children over 10 years old or when there is associated head injury or multiple fractures regardless of patients age.

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Treatment of Femoral Shaft Fracture with Intramedullary Nailing: A Comparison of Ender Nailing with Interlocking Intramedullary Nailing: Sung Tae Lee, In whan Jeong, Dong Heon Kim, Kyu Cheol Shin, Moon Koo Lee; J Korean Soc Fract 1996;9(2):409-415. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.409

Abstract PDF: The rigid internal fixation of the femoral shaft fracture with intramedullary nailing enables early joint motion and reduces morbidity. The authors reviewed the results of 38 patients treated with Ender nailing(22 casses) and interlocking intramedullary nailing(16 cases) between March 1989 and March 1994. The resuls were as follows. 1. The average bony union time in Ender nailing(18.9 weeks) was similar to interlocking intramedullary nailing(18.7 weeks). 2. The average time to acHieve full range of motion of the knee was shorter in intramedullary nailing (10.2 weeks) than in Ender nailing(13.5 weeks). 3. Interlocking intramedullary nailing required shorter time to achieve full weight Ender nailing. 4. The average operation time was shorter in Ender nailing(55 mins.) than in interlocking intramedullary nailing(100 mins). Interlocking intramedullary nailing is thought to be a better option than Ender nailing in fixa lion of femur shaft fracture by our study. However, in elderly patients or multiple injured patieilts, Ender nailing can be used advantageously for shorter operation time and technical sim plicity.

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A Comparison of the Using of Plate fixation and Ender nailing in Humeral Shaft Fractures: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Eim, Soo Dong Baek; J Korean Soc Fract 1996;9(1):161-169. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.161

Abstract PDF: The humerus is anatomically and physiologically unique bone: firstly, it is a non-weight bearing bone; secondly, it has greatest range of motion; thirdly, while the person is standing, the axis of bone hangs vertically and is influenced by gravity, and conservative methods are usually used in treatment. However. in the cases of closed reduction failure, open fracture, multiple fracture, and old age etc, operative methods may be employed. This decision should be based on the type, location of fracture. the presence of concomittent injuries, the age, and the general condition of the patient. When open reduction and internal fixation is carried out, the periosteum and soft tissue attachment is stripped off and operative time is longer Flexible Ender nailing is a simple procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, and decreases the chance of infection and allows early exercise. Authors carried out fixation in 28 patients and Ender nailing in 24 patients having humeral shaft fractures who were treated at the orthopedic department, Hae Dong hospital from March, 1990 to February, 1994.

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Comparison between Interlocking IM Nail and Ender Nail in the Treatment of Shaft Fracture of the Tibia: Dong Chul Lee, Sang Ho Lee, Se Dong Kim; J Korean Soc Fract 1995;8(4):830-840. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.830

Abstract PDF: The shaft of tibia is prone to the open wounds owing to the subcutaneous location and poor muscular envelope. The open wounds frequently result in the severe complications and major disabilities, such as infection, delayed union and nonunion. The choice of treatment should be considered cautiously. The intramedullary fixation of the shaft has the advantage of early weight bearing as well as relative firm fixation. Sixty four cases of fracture of the tibia shaft were treated with interlocking IM nail(38 cases) or Ender nail(26 cases) from December 1985 to January 1993. 1. The most common causes of the tibia fracture were the pedestrian injury and motorcycle accident. 2. There was no difference in operation time between interlocking IM nail group and 5 weeks in Ender nail group. the average time of operation was about 70 minutes. 3. The mean time of cast support was 2.5 weeks in interlocking IM nail group and 5 weeks in Ender nail group. The mean duration of nonweight bearing was 7.6 weeks in interlocking IM nail group,9.2 weeks in Ender nail group. 4. The mean duration of bone union was 18.7 weeks in interlocking IM nail group,21.4 weeks in Ender nail group. The interlocking IM nail group seemed to obtain earlier bone union(2.5 weeks) than Ender nail group, but there was no significance in statistical analysis in the bone union time between two groups. 5. Angular deformities were found in 3 cases in interlocking IM nail group and 4 cases in Ender nail group, which occured in the communited fracture and both ends fracture of the tibia shaft, segmental fractures. Delayed union was also occured in 5 cases in Ender nail group and 3 cases in interlocking IM nail group.

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Femoral Shaft Fracture Treated with Flexible Intramedullary Ender Nail: Beom Koo Lee, Young Ju Kim, Suk Woong Yoon, Jae Hee Cho, Byung Gug Lee; J Korean Soc Fract 1995;8(4):792-798. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.792

Abstract PDF: Various methods have been used in the treatment of femoral shaft fractures. Recently closed intramedullary interlocking nailing is recommended as one of the most successful methods, but its use is technically demanding and much exposure to radiation is needed. In comparison, flexible intramedullary nail such as Ender nail is easy to use and cause less damage to the patient. We used the Ender nail in the treatment of femoral shaft fracture from 1989 to 1993 and the result were as follows; 1. Average patient age is 38.2 years old and major cause of the fracture was traffic accident. 2. Bony union was obtained in 14 cases of 17 cases with primary operation. Average bony union time was 14.2 weeks. 3. Mean operative time was 40 minutes in Winquist-Hansen type I and II ,90 minutes in Winquist-Hanserl type III and IV. 4. Ender nail migration over 10mm was noted in 9 of 17 cases. Average migration was 10mm in knee and 24mn in trochanteric area. 5. Complication were as follows ; Nail migration causing pain in 9 cases, delayed union 4 cases, non-union 3 cases, varus deformity in 3 cases, shortening in 4 cases. In Winquist-Hansen type III and IV ,76.9% of cases suffered from some complication. 6. Flexible intramedullary nail was easy to apply but we thought that Ender nail is inadequate treatment method for Winquist-Hansen type III and IV because of high complication rate.

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Overall Review of the Treatment of Tibial Fracture by Endernailing: Technical Consideration of Ender Nailing on Tibial Fracture: Hyung Ku Yoon, Kwang Pyo Jeon, Dae Eun Jung, Ho Seung Jeon, Dae Young Jaang; J Korean Soc Fract 1995;8(2):370-377. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.370

Abstract PDF: Fractures of the tibia are one of the most common injury encountered by orthopaedic surgeons and their treatments are considered to be difficult due to serious complications. Many treatment modalities were introduced. Among them, Ender nailing is considered one of the useful modality because it is a relatively simple and, 3ess invasive procedure Authors analized 123 tibial fractures treated with Endr nails from Feb. 1986 to Feb. 1992 to solve the problems during Ender nailing. The follow up ranged from 12months to 51 months with an average of 11 months. The results are as follows; 1. Among 123 patients,93 cases are male and 30 cases are female. Traffic accident is the most common cause of injury. 2. Average interval from injury to operation is 9 days and average 2.1 Ender nails are used. The mean duration of the bone union is 19.1 weeks. 3. To prevent knee joint pain, more distal medial and lateral portal of entry and more posteriorly located lateral portal of entry were used. 4. To provide stability of distal 1/3 fracture,3 or more nails are introduced with fanning in AP and lateral plane. 5. to provide stability of the comminuted fractures, convexities of at least 2 nails are located at the comminuted site. 6. To prevent rotation of the middle fragments of segmental fractures, technique of temporary Steinmann pin fixation for handling the middle fragment during operation were used.

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Surgical Mangement of the Fracture of the Humeral Shaft: A comparison using of B%ate fixation and Ender nailing: Ki Soo Kim, Young Soo Choi, In Kyu Baik, Se ln Oh; J Korean Soc Fract 1995;8(1):173-180. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.173

Abstract PDF: The treatment of humeral shaft fractures remains controversal. The decision should be based on the type and location of the fracture, The presence of concomitant injuries, and the age and condition of the patient. Auhors reviewed and analyzed plate fixation in 30 patients and Ender nailing in 21 patients having humeral shaft fractures. These patients were treated at the Department of Orthopaedic Surgery, Kwang ju Christian Hospital from January 1988 to December 1993. The results were as follows, 1. Males had a dominant incidence in social active age groups, the major causes of these injuries were traffic accidents. 2. Most of surgical indications were polytrauma patients in Ender nailing groups, while flilure of conseuative management and radial nerve palsy in plate fixation groups, The bony union rate was 80.9% in Ender nailing groups and 100% in plate fixation groups. 3. Among the seven radial nerve palsy sustaining high energy accidents two cases had poor results. Nonunion of the humeral shaft fracture occured in four cases and were associated with insecure fixation, distraction of fracture site and open fracture. these four patients were only in the Ender nailing groups. When surgical management is indicated, internal fixation using plate osteosynthesis combining interfragmentary compression can give good results. Closed intramedullary Ender nailing have advantages and can be performed effectively in selected fractures of the humeral shaft such as polytrauma patients.

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Comparision of Ender Nailing with Sliding Screw Plate Fixation in Intertrochanteric Fracture: Dong Heon Kim, Young Roon Kim, Kyeong Soon Kim; J Korean Soc Fract 1994;7(2):545-552. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.545

Abstract PDF: A sliding screw plate is the most commonly used device for the fixation of intertrochanteric hip fractures, providing secure fxation and controlled impaction but several complications, such as penentration of lag screw, back out of lag screw, wide skin incision and relatively long operation time, have been reported. An intramedullary device has been introduced as an alternative method. Ender nailng for intertrochanteric fracture of femur has many advantages such as minimal operative trauma and blood loss, short operation time, low incidence of infection, good stability of fracture and early ambulation. The authors have treated 45 cases of intertrochateric fracture from March 1988 to July 1994 with sliding screw plate(25 cases) or Ender nailing(20 cases). The results are as follows : 1. The ratio between men and women was 1 : 1.5 and the average age was 69 years old. 2. The most common causes were slip down injury followed by traffic accident and fall down injury. 3. Follow-up period was 16 to 34 monthes(average 23 monthes). 4. The most common type of fractures was Tronzo type III. 5. The average bony union time was about 14.2 weeks in sliding screw plate group and 15.1 weeks in Ender nailing group. 6. The most common complications were progressive varus deformity in SSP group and pain & limited ROM of knee joint in Ender nailing group. 7. The outcome was satisfactory in both group.

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Treatment of Comminuted Subtrochanteric Fractures of the Femur with Ender Nails: Kwon Ick Ha, Sung Ho Hahn, Min Yeong Chung, Bo Kyu Yang, Jae Hoon Ryu; J Korean Soc Fract 1994;7(2):345-351. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.345

Abstract PDF: The subtrochanteric fracture of the femur is often comminuted because the bone here is mainly cortical and high velocity trauma and hiornechanically and adjacent power muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, mechanical failure, and many other problems can be encountered. We studied 6 comminuted subtrochanteric fractures treated with Ender nails from Sept. 1991 to Oct. 1992. 3 weeks of skin or skeletal traction followed by partial weight bearing postoperatively showed excellent outconles.

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Clinical Study of Nonunion of Clavicle in Adult: Dae Yong Han, Ik Hwan Yang, Jo Hyung Lee; J Korean Soc Fract 1992;5(2):356-364. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.356

Abstract PDF

Although the clavicle is one of the most commonly fractured bone, nonunion is rare. The authors experienced 15 cases of clavicle nonunion in adult who were admitted and treated at the Department of Orthopedic Surgery of Severance Hospital during period from January 1983 to December 1990 (eight years). This study focused on the predisposing factors in relation to nonunion of clavicle and the analysis of the results after operative treatment The results of analysis wire as follows ; 1. Predisposing factors of nonunion were primary operative treatment with inadequate fixation, middle 1/3 of clavicle, severe associated injury and initial gross displacement of fracture fragment. 2. Among the 15 patients, 14 patients were treated with plate and screw fixation and autogenous iliac bone graft. One patient was treated by metal removal due to infected nonunion. 3. Using a rating scale of excellent(no apparent fractors), good(one factor), fair(two factors), poor(more than three factors), the result showed, 12 excellent, 1 good, and 2 poor 4. Amonf the is opeTative treatment, there was only one case of complication which was metal failure. It was concluded that symptomatic nonunion of the clavicle could be treated by operation. and the procedure of choice seemed to be rigid internal fixation with plate and bone graft.

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Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Jung-Ho Kang, Kwang-Hee Park
Journal of the Korean Fracture Society.2007; 20(3): 233. CrossRef

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Treatment for Two-part Fracture of the Humerus Surgieal Neck by Ender Nailing: Choong Gil Lee, Jin Woo Kwon, Soo Yong Kim, Kyung Tae Son; J Korean Soc Fract 1992;5(2):348-355. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.348

Abstract PDF: There is no consensus on the best way to treat complicated fractures of the proximal humerus. We treated two-part surgical neck fractures which were not suitable for conservative method by semi-open reduction and Ender nailing with addition of cancellous bone graft. This method provided good three-point fixation and then early ROM exercise was possible even in case of osteoporotic or severely comminuted surgical neck fractures. Between June 1989 and February 1992, Ender nailinss were performed for two-part surgical neck fractures, and among those cases 16 were followed for more than 1 year. The results of study were as follows ; 1. All cases were treated by seml-open reduction and Ender nailing with additional cancelous bone graft. 2. Ender nails were inserted through retrograde entry in all cases. 3. Complications developed in 3 cases ; one case of proximal migration of Ender nail and two of shooter joint partlal stiffness. 4. The mean duration of radiologic bone union was postoperative 9 weeks. 5. According to Neer criteria 11 cases were good, 3 fair and 2 poor results.

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Treatment of Intertrochanterie fracture of the Femur with Ender Nails in the Elderly Patients: Seong Taek Kim, Ki Soo Kim, Yeub Kim, Seung Hee Koh, Yong Soo Choi, Sang Tae Park; J Korean Soc Fract 1992;5(2):300-308. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.300

Abstract PDF: The incidence of intertrochanteric fracture of the femur in the elderly patient has been increased progresslvely due to the prolongation of Korean average life span and improvement of the medical survice. The mortality. however, in these elderly patients is relatively high. Rigid internal fixation of intertrochanteric fracture with early mobilization of the patient has in recent years reduced the mortality and morbidity. From September 1984 to August 1991, the authors had treated with Ender nails for 126 cases of intertrochanteric fracture. From 109 cases followed more than six months, the clincal results were as follows. 1. The average age was 74.8 years. 2. 73 cases (67%) were unstable fractures and 36 cases (33%) were stable fractures by Evans classification. The most common type was type 3 (35.8%) by the Tronzo classification, A2 type(55.1%) by the AO classification. 3. The main indication were stable fracture, unstable fracture over 70 years old, high anesthe tic resk, severe osteoporosis and wound at greater trochanter. 4. Intraoperatlve complications were experienced in 37 cases(33.9%). The improper entry hole site was most common. 5. Postoperative complications occured in 57 cases(52.3%) and more frequently in unstable fractures(57.5%). The most common complication was knee joint pain in 45 cases (41.3%) 6. Recently, patients who had Ender nails with Knowles pins showed good results in the presence of severe osteoporosis or unstable fracture.

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Treatment of intertrochanteric fracture with ender nails over theage of 60 years old: Sang Ho Ha, Jae Won You, Sang Hong Lee, Young Bae Pyo, Yeon Seob Rowe; J Korean Soc Fract 1991;4(2):281-288. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.281

Abstract PDF: No abstract available.

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Supracondylar Fracture of the Femur Treated by Ender Nail: Yong Ju Kim, Suk Woong Yoon, Bum Goo Lee, Sung Il Shin; J Korean Soc Fract 1990;3(1):62-70. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.62

Abstract PDF: The supracondylar fracture of the femur is very difficult to treat regardless of whether non-surgical of surgical methods are selected. Recent advance of device for internal fixation such as AO angle plate and Judet plate improved the result of the operative treatment. But the operative technizue is difficult and in elderly patient rigid fixation can not be obtained due to osteoporsis and comminution of the fracture. So intramedullary nailing such as Zickel supracondylar element were treated with the Ender anil with distal screw in Red Cross Hospital from September 1987 to December 1988. Ender nailing appear to be a promising treatment of the supracondylar fracture of the femur, especially elderly patient, because the operaive technique is easy, blood loss is minimal and fixation is adequate to allow early exercise of the knee.

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