Clinical outcomes following treatment of extracapsular hip fractures with long versus short cephalomedullary nails
Goh EL., Png ME., Metcalfe D., Achten J., Appelbe D., Griffin XL., Cook JA., Costa ML.
Aims: The use of cephalomedullary nails for the fixation of extracapsular hip fractures has risen 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 multi-centre, prospective cohort study that collected data from patients ≥ 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 healthrelated QoL (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 ratios associated with treatment with a short cephalomedullary nail compared to a long cephalomedullary nail for mortality was 0.96 (95% CI: 0.70 to 1.30, p = 0.772); re-operation 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 versus short cephalomedullary nails for an extracapsular hip fracture experienced a similar recovery in quality of life. 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 nail according to the fracture type and patient factors in the knowledge that both implants provide similar outcomes.