Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Vol 5 | Issue 1 | Jan-April 2019 | page: 17-22  |Rohan R Memon, Drashtant Patel

Author: Rohan R Memon[1], Drashtant Pate[l1]

1 Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad

Address of Correspondence
Dr. Rohan Rafik Memon,
Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad


Background: Intertrochanteric Femur fracture is common in elderly patient with co-morbidity.Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis.
Aims and objectives;  we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures.
Study Design: This is a prospective observational type of study
Place and duration of studyDepartment of orthopaedics, NHL medical college between January 2015 to June 2018
Methodology: 52 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2015 to june 2018. We included those patients having age ≥50 years, with multiple co- morbid conditions like diabetes, hypertension, COPD, Asthma, bleeding disorders and multiple fractures, and duration of the Intertrochanteric fracture ≤ two week. We exclude young active patients < 50 yrs age, fracture > 2 weeks duration, fracture with lateral wall comminution and open fractures. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head.
Results; All the fractures were united within an average period of 13 weeks with a range of 10 – 13 weeks. The functional assessment was done with modified Harris hip score(Table no 1,2) and the mean was 86.3 with a range from 73 to 95 , and 26 patients were excellent, 20 patients were good , 4 patients were fair and two patients were poor with respect to total score. The analysis of this study fulfils the objectives of good functional outcome
Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.
Keywords: Compression screw, Ender nails, osteoporosis, inter-trochanteric fracture


[1]. Rockwood and Green;s Fracture in adults, 8th edition: vol.2:2075-2130.

[2]. Hagino H, Furukawa K, Fujiwara S, et al. Recent trend in the incidence and lifetime risk of hip fractures in Tottori, Japan.Osteoporos Int. 2009;20(4):543-548.

[3]. Lawton JO, Baker MR, Dickson RA. Femoral neck fracture: two populations. Lancer 1983;2:70-72.

[4]. Atkin JM. Relavance of osteoporosis in women with fractures of the femoral neck. Br Med J 1984;288’:597-601.Pogrund H, Makin M, Robin G, et al. Osteoporosis in patients with fractured femoral neck in Jerusalem. Clin Orthop 1977;124:165-172.

[5]. Ender J, Simon-Weidner R. Die Fixierung der trochantener bruche mit runden elastischen Kondylennageln. Acta Chir Austria1970;1:40.

[6]. Bonnaire F, Weber A, Bosl O, Eckhardt C, Schweiger, Linke B. “Cutting out” in pertrochanteric fractures – problem of osteoporosis. Unfallchirurg. 2007;110:425–32.

[7]. Beidle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures femur – randomized prospective comparison of gamma nail and dynamic hip screw. JBJS Br. 1991;73:330–4.

[8]. Nordin S, Zulkifil O, Faisham WI. Mechanical failure of DHS fixation in intertochanteric fracture femur. Med J Malaysia. 2001;56:12–7.

[9]. Fogognolo F, Kfuri M, Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with PFN. Arch Orthop Trauma surgery. 2004;124:31–7.

[10]. Wojcik B, Tokarowski A, Swieboda A, Kaleta M, Nowak R. Endernails in the stabilization of trochanteric fracture in elderly. Chir Narzadow Ruchu Ortop Pol. 1999;64:279–83.

[11]. Raughstad TS, Moister A, Haukeland W, Hestenes O, Olerud S. Treatment of petrochanteric and subtrochanteric fractures of the femur by the Ender metod. Clin Orthop. 1970;138:321.

[12]. Pankovich AM, Tarabiski IE. Ender nailing of intertrochanteric fractures of femur. J Bone Joint Surg. 1980;62A:635.

[13].Cobelli NJ, Sadler AH. Ender rod versus compressive screw: fixation of hip fracture. Clin Orthop. 1970;138:321

[14]. Moon MS, Woo YK, Kim ST. A clinical study of trochanteric fractures of the femur: Outcome of the treatment in regard to osteoporosis and type of the treatment. I Korean Orthop Assoc. 1991;26:1693–702.

[15]. Russian LA, Sonni A. Treatment of intertrochanteric and subtrochanteric fractures with Ender intramedullary rods. Clin Orthop. 1980;148:203–12.

[16]. Kuderna H, Bohler N, Colby AJ. Treatment of intertrochanteric and subtrochanteric fracture of the hip by the Ender method. J Bone Joint Surg. 1976;58:604–11.

[17]. Hall LG. Comparison of nail-plate fixation Ender’s nailing for intertrochanteric fractures. J Bone Joint Surg. 1981;63-B:24–8.

[18]. Parker MJ, Handoll HH, Bhonsle S, Gillespie WJ. Condylocephalic nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2000;2:CD000338.

How to Cite this article:  Memon R R, Patel D. Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition. Journal of Bone and Joint Diseases Jan – Apr 2019;5(1):17-22.


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Cannulated Cancellous Screw and Ender’s Nail Fixation in
Stable Intertrochanteric Femur Fracture in Elderly Patient
With Co-Morbid Condition