Clinical outcomes following treatment of extracapsular hip fractures with long compared with short cephalomedullary nails.
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Goh En Lin, Png May Ee, Metcalfe David, Achten Juul, Appelbe Duncan, Griffin Xavier L, Cook Jonathan A, Costa Matthew L, WHiTE Investigators, 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
Аннотация
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.