A randomized, prospective study comparing Ender nailing with external fixation for open fractures of sixty-three tibiae (sixty patients) was undertaken. Ender nailing proved to be at least as effective as external fixation with respect to seven parameters: time to union, tibial alignment, total number of operations, ranges of motion of the knee and ankle, pain, presence of infection, and complications. Ender nailing is a safe alternative to external fixation for grade-I and grade-II open fractures. It should not be used for comminuted fractures, which might shorten about the nails.
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Holbrook et al. (1989) studied this question.