Publication

Clinical outcomes following treatment of extracapsular hip fractures with long compared with short cephalomedullary nails

Abstract
Aims: The use of cephalomedullary nails for the fixation of extracapsular hip fractures has increased in recent years, but high-quality evidence to guide surgical decision-making between long and short cephalomedullary nails is lacking. The aim of this study was to compare the quality of life (QoL) and the risks of mortality and complications in patients treated with long and short cephalomedullary nails. Methods: The World Hip Trauma Evaluation (WHiTE) study was a multicentre, prospective cohort study that collected data from patients aged ≥ 60 years who received operative treatment for their hip fracture. Patients were followed up for 120 days after surgery. The primary variable of interest was cephalomedullary nail type (long or short). The primary outcome was health-related QoL (EuroQol five-dimension five-level questionnaire (EQ-5D-5L)). The secondary outcomes were mortality and complications. Linear and Cox proportional hazards regression models were fitted to assess the relationship between cephalomedullary nail type, EQ-5D-5L, mortality, and complications, respectively. Results: Among 2,640 patients with an extracapsular hip fracture, 2,014 patients were treated with a long cephalomedullary nail and 626 patients with a short cephalomedullary nail. The adjusted mean difference in EQ-5D-5L in patients treated with a long and short cephalomedullary nail was 0.02 (95% CI -0.01 to 0.05; p = 0.144). The adjusted hazard ratio associated with treatment with a short cephalomedullary nail compared with a long cephalomedullary nail for mortality was 0.96 (95% CI 0.70 to 1.30; p = 0.772); reoperation 0.97 (95% CI 0.54 to 1.76; p = 0.919); fixation failure 1.20 (95% CI 0.47 to 3.06; p = 0.710); peri-implant fracture 0.97 (95% CI 0.30 to 3.17; p = 0.959); surgical site infection 1.06 (95% CI 0.60 to 1.86; p = 0.838); and blood transfusion 0.52 (95% CI 0.37 to 0.72; p < 0.001). Conclusion: Patients treated with long and short cephalomedullary nails for extracapsular hip fractures experienced a similar recovery in QoL. The implants had similar risk profiles in terms of mortality and surgical complications, although the risk of blood transfusion was higher after treatment with a long cephalomedullary nail. Surgeons may choose between long and short cephalomedullary nails according to the fracture type and patient factors in the knowledge that both implants provide similar outcomes.
Author
Goh, En Lin
Png, May Ee
Metcalfe, David
Achten, Juul
Appelbe, Duncan
Griffin, Xavier L
Cook, Jonathan A
Costa, Matthew L
Barrett, Michael
Hull, Peter
Melling, David
Kosy, Jonathan
Charalambous, Charalambos P
Butler, Oliver Keast-
Magill, Paul
Yarlagadda, Rathan
Vashista, Girish
Savaridas, Terence
Sturridge, Seb
Smith, Graham
Dasari, Kishore
Bhaskar, Deepu
Bajada, Stefan
Bigsby, Ewan
Mahmood, Ansar
Dunbar, Mark
Jimenez, Andrea
Wood, Ryan
Penny, James
Eardley, William
Handley, Robert
Srinivasan, Suresh
Gee, Matt
Kulkarni, Ashwin
Davison, John
Maqsood, Mohammad
Sharma, Amit
Peach, Chris
Sheeraz, Ahsan
Page, Piers
Kelly, Andrew
McNamara, Iain
Longstaff, Lee
Reed, Mike
Moppett, Iain
Sorial, Ayman
Joachim, Theophilus
Ng, Aaron
Gallagher, Kieran
Farrar, Mark
Ghande, Ad
Bird, Jonathan
Rajagopalan, Shyam
McAndrew, Andrew
Sloan, Andrew
Middleton, Rory
Remedios, Ian Dos
McClelland, Damian
Rogers, Benedict
Berstock, James
Bhatnagar, Sharad
Diamond, Owen
Fearon, Paul
Gill, Inder
Dunlop, Doug
Chesser, Tim
Acharya, Mehool
Sree, Deepak
Craik, Johnathan
Hutchinson, David
Johnson, David
Elgalli, Mosab
Dixon, Paul
Ellapparadja, Pregash
Slater, Guy
Kozdryk, Jakub
Young, Jonathan
Ollivere, Ben
Mohanty, Khitish
Faisal, Mohammad
Clark, Callum
Dhinsa, Baljinder
Malek, Ibrahim
Heaton, Sam
Blocker, Oliver
Theivendran, Kanthan
Citations
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Date
2025-12-01
Type
Article
Subject
Orthopaedics, Hip Fractures
Collections
Research (Articles)
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Citation
Goh EL, Png ME, Metcalfe D, Achten J, Appelbe D, Griffin XL, Cook JA, Costa ML; WHiTE Investigators; Barrett M, Hull P, Melling D, Kosy J, Charalambous CP, Butler OK, Magill P, Yarlagadda R, Vashista G, Savaridas T, Sturridge S, Smith G, Dasari K, Bhaskar D, Bajada S, Bigsby E, Mahmood A, Dunbar M, Jimenez A, Wood R, Penny J, Eardley W, Handley R, Srinivasan S, Gee M, Kulkarni A, Davison J, Maqsood M, Sharma A, Peach C, Sheeraz A, Page P, Kelly A, McNamara I, Longstaff L, Reed M, Moppett I, Sorial A, Joachim T, Ng A, Gallagher K, Farrar M, Ghande A, Bird J, Rajagopalan S, McAndrew A, Sloan A, Middleton R, Remedios ID, McClelland D, Rogers B, Berstock J, Bhatnagar S, Diamond O, Fearon P, Gill I, Dunlop D, Chesser T, Acharya M, Sree D, Craik J, Hutchinson D, Johnson D, Elgalli M, Dixon P, Ellapparadja P, Slater G, Kozdryk J, Young J, Ollivere B, Mohanty K, Faisal M, Clark C, Dhinsa B, Malek I, Heaton S, Blocker O, Theivendran K. Clinical outcomes following treatment of extracapsular hip fractures with long compared with short cephalomedullary nails. Bone Joint J. 2025 Dec 1;107-B(12):1325-1332. doi: 10.1302/0301-620X.107B12.
Journal / Source Title
The Bone & Joint Journal
DOI
URI
https://hdl.handle.net/20.500.14200/9706
PMID
Publisher
British Editorial Society of Bone and Joint Surgery
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