Purpose:The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device.Methods:Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study.Age,sex,ASA grade,timing of surgery,preoperative and postoperative haemoglobin,length of hospital stay,fracture type,number of units transfused and 30-day mortality were recorded.Results:The mean age was 82.3 years.Forty-seven patients underwent a short nail and 32 patients a long nail;53.4％ patients required blood transfusion postoperatively.Transfusion was required in 71.8％ of the long nails (p ＜ 0.05),65.8％ patients above the age of 80 (p ＜ 0.05),100％ of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 (p ＜ 0.05).78.5％ patients with A2 fracture and 75％ of A3 fractures needed blood transfusion (p ＞ 0.05).Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p ＜ 0.05).55.1％ operated within 36 h and 47.6％ operated after 36 h of admission needed transfusion (p ＞ 0.05).Thirty-day mortality in patients needing blood transfusion was 5％ and in non-transfusion group was 3.7％ (p ＞ 0.05).Conclusion:Patient age,ASA grade,preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.