Ulnar Insufficiency Fractures in Patients on Prolonged Bisphosphonate Therapy: A Case Report

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.

Treatment of femoral shaft fractures in young children by Ender’s nail: indications & complications.

Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.

Study Of Ender’s Nailing In Subtrochanteric Fracture Of Femur In Adults.

Abstracts: Background: Fractures of the subtrochanteric area of the femur represents a difficult therapeutic problem for the orthopaedic surgeon. Comminution, high stress concentration and osteoporosis in this region can lead to failure of fixation, shortening and nonunion. Favourable mechanical conditions are obtained following flexible intramedullary nailing like Ender’s nailing,because axial forces are distributed along the entire length of the nail and bending moments are minimized. Compression of the fracture fragments occur without excessive stress on the nails, enabling the patient to bear weight on the extremity. Methodology: This is a study of 34 cases of subtrochanteric fractures of femur in adults treated by Ender’s nailing at our place. Age ranging from 19 to 70yrs..In our study patient’s distribution according to frank-seinsheimer classification was as follows : Type I: nil, II-a: 1 pt., II-b: 5 pts., II-c: nil, III-a: 10 pts., III-b: 5 pts., IV: 5 pts., V: 8 pts. All the patients were having close fracture. We used 4.5 Enders nails in all patients. In 24 pts.total 3 nails and in 10 pts.total 4 nails were used. In 5 patients open reduction and encirclage wiring was done. In all other patients close reduction was done. Results: Average union time was 15 weeks. No pt. got postope. infection. Excellent and good results were found in 27 pts.out of 34 pts. Conclusion: Average duration of surgery was 1 hour and 10 minutes. Per-operative average blood loss was only 75cc. Post- operatively 23 patients out of 34 patents started partial weight bearing walking from 1stpost operative day. Union rate was 97%, no malunion in coxavara, 6% patient got external rotation deformity.

Study of results of ender nailing and cannulated cancellous screw in the treatment of intertrochanteric fracture femur.

Background: Intertrochanteric fracture of femur is one of the most common fractures seen in general population. Till date various fixation devices are used for fixation of this fracture that includes both extra medullary and intramedullary implants. Ender and Simon Weidner popularised the condylocephelic intramedullary nailing for this fracture. But it is seen that fracture treated by ender nailing alone resulted in varus malunion. Aims & Objective: Along with ender nail we added the cannulated cancellous screw which results in controlled collapse of the fracture with union in anatomic position. Material and Methods: We studied 50 patients of intertrochanteric fracture treated by ender nail and cannulated cancellous screw between year 2009 to 2011. Follow up assessment was done by Harris hip score. Results: The union achieved in mean time of 7 weeks. In study of 50 patients we obtained 86% excellent to good results. 14% patient had fair to poor results. Conclusion: We found that use of Ender nail and cannulated cancellous screw results in fracture union in more anatomical position with better patient compliance and early mobilization.

Ender Nailing of the Tibial Shaft Fractures under the Local Anesthesia

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.

Modified Ender Nailing For Intertrochanteric Fracture of the Femur

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.

Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia

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.

Treatment of Supracondylar Fractures Following Total Knee Arthroplasty

Supracondylar fractures of the femur following total knee arthroplasty are rare complication with reported rates ranging from 0.3% to 2.5%. Union of the fracture in proper alignment, without disruption of prosthetic component fixation and with maintenance of 90 of knee motion, is impotant in treatment of this type of fracture. Modalties of treatment are conservative or operative methods and operative treatment are open reduction 4 internal fixation, intramedullary nailing, revision arthroplasty using a prosthesis with a long stem and closed reduction and external fixation, but there are controversies in the method of treatment. Between Apr. 1989 and Jul. 1994, 10 patients were treated for supracondylar fracture of the ipsilaterai femur following total knee atthroplasty and 2 cases of them had arthrop]asty at other hospital. Average age of patients was 53 years (29-68 years), nine patients were women and one was man. The preoperative diagnosis was rheumatoid arthritis in four, degenerative osteoaithritis in three, posttraumatic osteoarthritis in one and tuberculosis sequelae of the knee in two. In nine cases mechanism of injury were slip down and in one was fall down. The interval hetween arthroplasty and fracture was an average of 22 months (9-79months). Two cases we.re treated with closed reduction and cast immobilization, one case was treated with open eduction and in1ernal fixation and seven patients of' ten cases were treated with closed intramedullay Ender nailing. The average foIlow-up period after fracture was 25 months (3 - 74months). We evaluated the results as the range of motion, bony union at simple radiograph and Knee Rating Score of Hospital for Special Surgery at last follow up. Eight cases of supracondylar fracture occuned among 350 patients, 514 cases of total knee arthroplasty which were operated at Kyung Hee Univcrsity Hospital between Apr. 1989 and Jul. 1994 and incidence was 1.6%. At the last follow up, all 10 cases achieved bony union and 7 cases using Ender naiIing achieved clinical bony union which enabled patients to do weight-bearing without pain at postoperative 6-8 weeks and radiological union was achieved at postoperative 12 weeks. Range of motion were average 105 degrees (80 J.20 degrees) hefore fracture and 86 degrees (6S 120 degrees) at the last follow up and HSS Knee rating score were average 80.3 points (59 94 points) before fracture and average 78.8 points (66-89 points) at the last follow up. At 7 cases using Ender nailing, range of motion were average 106 degrees (90 11S degrees) hefore fracture and 91 degrees (6S-105 degrees) at last follow up and HSS Knee rating score were average 80.6 points (59-94 points) before fracture and average 80.3 points (72-89 poiints) at the last follow up. Closed iintramedullary Ender nailing is a gecommendable operative method in the treatment of supracondylar fracture following total knee arthroplasty considering to good bony union, satisfactory functional result, easy operative technique and less postoperative complication.

Treatment of the Humerus shaft Fracture with Closed Interlocking medullary Nail / 대한정형외과학회잡지

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.

Clinical use of Ender Flexible Intramedullary Nail for the Proximal or Distal third Fracture of Tibia / 대한정형외과학회잡지

Authors reviewed 39 cases of proximal or distal fracture which had been managed with Ender flexible intramedullary nails to identify the proper region of tibial fracture for the nail and acceptable indication of retrograde nailing relevant to our clinical experiences. The results were as followings; l. Incidence of malunion with more than 10° of angulation was higher in the fracture of proximal 1/3 tibia than that of distal 1/3. Especially this phenomenon was more significant in case of combination with segmental fracture. 2. As all segmental fractures combined with proximal tibial fracture within 9cm from the plateau were malunited with angulation of 10° or more, another method of internal fixation should be considered. 3. Although degree of angulation was relatively larger in distal tibial fracture within 10cm from the plafond than that beyond 10cm and 2 cases of malunion with angulation of 10° or more were also found within 10cm from tibial plafond, there was no statistically significant difference. 4. Retrograde nailings were performed for 5 cases of proximal 1/3 fractures and 1 case of poor skin condition on the proximal entry. Clinical relevance: Suitable region of tivial fracture managed with Ender-flexible intreamedullary nail was fracture which occurred from 9cm distal to tibial plateau to 10cm proximal to tibial plafond.

The Complication in the Treatment Modality of Intertrochanteric Fracture of Femur / 대한정형외과학회잡지

Intertrochanteric fractures of femur were increasing in their incidence in morden life. The compression hip screw and Ender nail are popular treatment modalities of the interochanteric fracture of femur. We had tried to clarify the complications of intertrochanteric fracture according to the treatment modality-compression hip screw and Ender nail. We obtained the results as followings with the patients who had intertrochanteric fracture of femur which were managed by compression hip screw (56 cases) and Ender nail (22 cases) through the period of March 1987 to June 1993. The summary of the results; 1. Mechanical complications were developed in 9 patients(16%), 9 complications in the group with compression hip screw and 7 patients(32%), 12 complications in Ender nail. 2. Local complications were developed in 4 patients(7%) in compression hip screw and 10 patients (46%) in Ender nail and the most common local complication was the knee joint pain(7 patients; 32%). 3. Statistically, more significant decrease of neck-shaft angle was shown with group using Ender nail for unstable fracture than stable fracture group and compression hip screw group. 4. The degree of shortening was incrased in group with Ender nail than in group with compression hip screw, but there was no statistical significance. 5. The grade of osteoporosis was not related to the change of neck-shaft angle and shortening and also to the development of mechanical complication. According to the above results, compression hip screw was a more stable fixation device than Ender nail in the unstable intertrochanteric fracutre.

Comparative Study of Interlocking and Ender Nails fixation of Diaphyseal Fracture of Femur / 대한정형외과학회잡지

Interlocking and Ender nail fixations have been widely used for the surgical treatment of diaphyseal fractures of femur. Interlocking nail could give advantage of high stability to unstable, cominuted fractures. It requires, however, advanced technique and exposure to radiation harzard, often complicated by further comminution, displacement, breakage of drill bit or loosening of locking screws. Ender nail, on the contrary, is easier in procedure without reaming, thereby maintaining endosteum and requiring short operation time. It, however, cannot avoid complications of shortening, rotational deformity, migration of nails, etc. This study aimed at comparative evaluation of the clinical results of two different nailings(23 Interlocking and 19 Ender nails) performed from March 1987 to March 1993. The study materials were 42 femoral fractures out of 41 adult patients with the followed-up between one and seven years(average 3.5 years). The results are summarized as below: 1. Fracture occurred mostly in the mid-diaphysis(81%) and the Type III comminution(63%) was most common according to the Winquist-Hansen classifiaction. 2. The operative time averaged ninty five minutes in Interlocking nailing, while sixty minutes in Ender nailing. The blood loss was negligible in both techniques. 3. Fluoroscopic assessment after insertion of the nails revealed that Interlocking gave superior stability to Ender nail, while Ender nail produced earlier callus formation(7.5 weeks in average) than Interlocking nail(9.0 weeks in average, p 0.05). 4. Interlocking nail was complicated by loosening of locking screws in two, angulation in one, breakage of drill bit in one cases. Ender nail showed protrusion in two, limb shortening in three, rotational deformity in three cases respectively. There was neither operative infection nor nonunion.

Treatment of Fracture of Shaft of Humerus by Ender Nailing / 대한정형외과학회잡지

Authors presented the experience of Ender nail treatment for the humeral shaft fractures in 24 patients. The results of treatment in all were satisfactory, though there were four cases of delayed union. Bridging callus was formed at 8.2 weeks on an average. The average clinical union time was 14 weeks. No complications developed during nailing procedure. A case of radial nerve palsy after fracture recovered spontaneously. Longer nails which hit the end of medullary canal of distal fragment distracted the fracture gap, and resulted in delayed union in 4 cases. Therefore, it is recommended to use the proper size of nail to avoid the distraction effect of the inserted nail, and to use two nails at minimum for better fixation. However, when intramedullary Ender nailing is properly done, single nailing also can give consistently good anatomic and functional results.

The Use of Ender nails in Distal One-Third Fractures of Tibia / 대한정형외과학회잡지

The distal one-third fractures of tibia have much difficulty in treatment due to enumerous complications such as skin necrosis, angular deformity and delayed union. As for using Ender nails in distal tibial fractures, the stability of fixation can be strengthened with fanning of the nails in distal fragments and using more than 3 nails and 1cm longer nail. Twenty-two patients having distal tibial fractures, were carried out Ender nailing at Department of Orthopaedic Surgery, Maryknoll Hospital from May 1989 to September 1992. The results were as follows; 1. The distal end of fracture line was situated from 3cm to 9cm above plafond, and the mean duration of radiological bony union was 14.9 weeks except one case of nonunion. 2. Mild angulation developed in two cases and complications such as nonunion, superficial infection and backing out of nail were noted, but it did not affect the results.

Treatment of the Fracture of Distal Tibia with the Intramedullary Nailing (Comparison between Ender and Interlocking Nailing) / 대한정형외과학회잡지

Authors reviewed 42 fractures of distal tibia fixated with Ender nails(24 cases) or Interlocking nails(18 nails) at the Chosun university Hospital from 1986 to 1992. The purpose of this study is to compare the bony union, the complications and the functional results of two groups(Ender nailing group and Interlocking nailing group). The follow-up period was average 19 months(range, 12 to 36 months). The results were as follows 1. The most common causes of the injury were traffic accidents(36 cases). 2. In the Ender nailing group, 8 cases are closed fractures and 16 cases are open fractures. Among 24 cases, 14 cases are simple fractures and 10 cases comminuted fractures. In interlocking nailing group, 7 cases are closed fracture and 11 cases are open fractures. Among 18 cases, 8 cases are simple fractures and 10 cases are comminuted fractures. 3. The average radiologic union was obtained at 19.3 wks in Ender nailing group, and 18.1 wks in interlocking nailing group. 4. Major complication was a delayed union in both group(5 cases-Ender nailing group, 3 cases-Interlocking group). 5. According to the criteria of functional results by Klemm and Borner, we obtained a 87.5% of Excellent and good results in Ender nailing group(21 out of 24 cases) and 94.4% of Excellent and good results in Interlocking group(17 out of 18 cases). 6. There was no significant difference between the two groups in stable fractures of distal tibia, so we suppose that Ender nailing is a good technique in these cases due to its simplicity and the economic price. But in more unstable fractures such as long oblique, spiral and comminuted fractures, we think that intramedullary interlocking nailing is better due to its stability.

Ender Nailing with Distal Wiring Technique in the Treatment of Intertrochanteric Femoral Fracture / 대한정형외과학회잡지

In the treatment of elderly hip fracture, early mobilization as a means of reducing early postoperative morbiyt and morbidity is mandatory. Even though Ender nailing have many advantages, most serious problems with use of Ender nailing method are distal migration of nails, subsequent loss of fixation and limited knee joint motion. To prevent these difficult problems, we have used distal wiring technique with Ender nailing since 1988. In operation, we performed Ender nailing as usual manner under image intensifier and for the prevention of the nail migration, we performed circumferential wiring through the each Ender nail eye and above the adducter tubercle of the distal femur. Forty six cases were available with minimum follow-up of six months which were healed radiologically and clinically (Mean follow up: 21 months). The mean age was 74 years (Range: 52 years-88 years)and showed 26 cases of famale and 20 cases of male. The radiological morphometry using Singh index showed poor bone quality: 36 cases were below Grade III and the fracture type was classified by Tronzo criteria. In results, patients who had Ender nailing with distal wiring showed no distal migration, however one case of proximal migration was observed at the beginning stage of this technique. So, in elderly trochanteric fracture, to reduce the complication of the Ender nailing, especially nail migration, the authors recommend the Ender Nailing with distal wiring technique.

Treatment of the tibia shaft fractures with ender nails / 영남의대학술지

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their numerous complications. Thirty patients with fractures of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fracture and the remaining 11 were open. The comminuted and segmental fractures were 18 (57.7%) in number and the most common fracture site was the middle one third (53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.

Radiological Assessment of Progressing of bony Union after Ender Nailing in Acute Tibia Shaft Fracture / 대한정형외과학회잡지

Acute unstable tibial shaft fractures are common in these days of high energy trauma. There are many options for this common and complicated fracture. Flexible intramedullary nailing using closed technique is prevalent in that this has much technical, functional, and physiological advantages. We reviewed 51 cases of acute tibial shaft fractures treated with flexible intramedullary nailing. There were 3 nonunions (6%), and two refractures. Among 46 united cases, 8 cases (17 %) showed no bridging callus formation within 20 weeks. Followings are the results of average time reaching each of radiological bony progression stage for 46 united cases. l. Average time to earliest discernible callus formation (stage I) was 13.3 weeks (range:8-21 weeks). 2. Average time to definite and bridging callus formation (stage II) was 18.1 weeks (range:8-32 weeks). 3. Average time to some oblitetation of fracture line (stage III) was 32.8 weeks (range:17-50 weeks). 4. Average time to complete obliteration of fracture line (stage IV) was 14.0 months(range:12-18 months).

Treatment of Intertrochanteric Fractures of the Femur under 50 yrs. of age with Ender Nails / 대한정형외과학회잡지

Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fractures of the elderly patients, but it has been rarely used in younger patients because of serious complications such as shortening and external rotation deformity. Authors already contended that the incidence of such complications had intimate connection with the quality of bone, and accordingly with the age. To substantiate the contention, we analyzed thirty-four cases with more than one year follow-up among forty cases of intertrochanteric fractures treated with Ender nails during the period from 1982 to 1989. And the results are summarized as follows;1. The average age was 39 yrs., and the most common cause of fractures was fall from a height. 2. According to the Kyle et al. clsssification, stable fractures(type I & II ) were 13 cases(38%), and unstable fractures (type III & IV) were 21 cases(62%). 3. According to the Singh's index, the good in bone quality(Grade 4, 5, & 6) were 31 cases(91 %), and the poor(Grade 1, 2, & 3) were only 3 cases(9%). 4. Postoperative complications occurred in 6 cases(17%), which included ROM limitation of knee joint in three cases(9%), proximal migrations of nails in two(5%), and distal migrations of nails in one(3%). Among them, 4 cases required revisional operations. There was no case with apparent external rotation deformity over 20 and shortening over 2cm. 5. It is thought that, contradictory to common beliefs, Ender nailingis a safe method for intertrochanteric fractures of femur in younger patients with good bone quality, but requires some experiences and cautions to prevent such complications as external rotation deformity and shorterning.

The Use of Ender nails in Distal Tibial Fractures / 대한정형외과학회잡지

Fracture of distal one third of tibia is prone to develop angular deformity during weight bearing and delayed union by inadequate immobilization. Most surgeons have performed internal fixation with plate and screws or interlocking Kuentscher nail to provide stability to the fractured tibia. When open reduction and internal fixation is carried out, the periosteum and muscular attachments must be stripped off. And in interlocking Kuentschernailing extraoperative time needed to insert distal screw, and the medullary reaming destroys nutrient circulation by which fracture healing is hindered. However, flexible Ender nailing is a simple procedure which does not necessitate reaming, and also does not disrupt or strip off soft tissues at the fracture site. Authors carried out Ender nailing in 16 patients having distal tibial fractures who were treated at the Orthopaedic Department, Kang-Nam St. Mary's Hospital from February, 1985 to December, 1988. The results are as follows: 1. The radiological union was obtained at 13.3 weeks after operation, and primary healing was taken place. 2. Fractures could be securely fixed by intramedullary Ender nailing. 3. Mild angulation developed in 3 cases, but it did not affect the results. Through the results Ender nailing is proven to be an effective, reliable, and safe method in treatment of fracture of the distal one third of tibia with minimum residua and complication, and brings the natural fracture healing.