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Comparative Study
. 2025 Dec 1;107-B(12):1325-1332.
doi: 10.1302/0301-620X.107B12.BJJ-2025-0482.R1.

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

En Lin Goh  1 , May Ee Png  2 , David Metcalfe  1 , Juul Achten  1 , Duncan Appelbe  1 , Xavier L Griffin  3 , Jonathan A Cook  4 , Matthew L Costa  1 ; WHiTE Investigators; Michael Barrett, Peter Hull, David Melling, Jonathan Kosy, Charalambos P Charalambous, Oliver Keast- Butler, Paul Magill, Rathan Yarlagadda, Girish Vashista, Terence Savaridas, Seb Sturridge, Graham Smith, Kishore Dasari, Deepu Bhaskar, Stefan Bajada, Ewan Bigsby, Ansar Mahmood, Mark Dunbar, Andrea Jimenez, Ryan Wood, James Penny, William Eardley, Robert Handley, Suresh Srinivasan, Matt Gee, Ashwin Kulkarni, John Davison, Mohammad Maqsood, Amit Sharma, Chris Peach, Ahsan Sheeraz, Piers Page, Andrew Kelly, Iain McNamara, Lee Longstaff, Mike Reed, Iain Moppett, Ayman Sorial, Theophilus Joachim, Aaron Ng, Kieran Gallagher, Mark Farrar, Ad Ghande, Jonathan Bird, Shyam Rajagopalan, Andrew McAndrew, Andrew Sloan, Rory Middleton, Ian Dos Remedios, Damian McClelland, Benedict Rogers, James Berstock, Sharad Bhatnagar, Owen Diamond, Paul Fearon, Inder Gill, Doug Dunlop, Tim Chesser, Mehool Acharya, Deepak Sree, Johnathan Craik, David Hutchinson, David Johnson, Mosab Elgalli, Paul Dixon, Pregash Ellapparadja, Guy Slater, Jakub Kozdryk, Jonathan Young, Ben Ollivere, Khitish Mohanty, Mohammad Faisal, Callum Clark, Baljinder Dhinsa, Ibrahim Malek, Sam Heaton, Oliver Blocker, Kanthan Theivendran
Affiliations
Comparative Study

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

En Lin Goh et al. Bone Joint J. .

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.

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Conflict of interest statement

J. Achten's and M. L. Costa's employer, the University of Oxford, receives research grant funding from the National Institute for Health and Care Research (NIHR) and Wellcome for research into musculoskeletal trauma, unrelated to this study. D. Appelbe reports NIHR grants (NIHRDHNIHR128399 / NIHRDH-NIHR201943 / NIHR134839) for this study. E. L. Goh reports a NIHR Doctoral Research Fellowship. X. L. Griffin is supported by NIHR Barts Biomedical Research Centre, is Chair of the SICOT Research Committee and British Orthopaedic Trauma Society, Research Committee and President Elect Oversight Group Member for the Data Monitoring Committee for NIHR159676 – The PORTRAIT trial, member of the British Orthopaedic Association (BOA) and Fragility Fracture Liaison Service National Audit, Chair of the BOA Research Committee, member of the Research and Innovation Committee of NHS England Outcomes and Registries Programme, Co-theme Lead for Precision Musculoskeletal Care Theme of NIHR Barts Biomedical Research Centre, and Royal College of Surgeons of England (RCS) England and British Orthopaedic Association Surgical Specialty Lead (Orthopaedic Trauma) for Research. D. Metcalfe reports institutional payments from the NIHR Oxford Biomedical Research Centre to support infrastructure necessary to complete this project, as well as a NIHR Advanced Fellowship and institutional payments from the Kadoorie Charitable Foundation, and royalties from Oxford University Press, which are unrelated to this study.

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