A systematic review of all randomised trials comparing the use of Ender nails with alternative implants for the reconstruction of extracapsular fractures of the proximal femur has been conducted. Wherever possible the results for the 1.570 patients in the 10 trials identified were pooled. Apparent advantages of Ender nails were reduced deep wound sepsis rate, shorter duration of surgery and lower operative blood loss, but they were associated with an increased risk of re-operation and fracture of the femur. Ender nails were also associated with an increased risk of cut-out of the implant from the femoral head when compared with a sliding hip screw, although not when compared with a fixed nail plate. Additional problems associated with Ender nails included backing out of the nail, shortening of the leg, external rotation deformity and residual pain. The continued use of Ender nails in the fixation of proximal femoral fracture is inappropriate.
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