No abstract

Objective: To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA). Design: Retrospective case series. Patients: Twenty-seven skeletally mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System with 8 patients subsequently experiencing backout of distal interlocking screws. Intervention: The study intervention included retrospective review of patient charts and radiographs. Main Outcome Measure: The incidence rate of distal interlocking screw backout. Results: Thirty percent of patients experienced the backout of at least 1 distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-Advanced system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30–139 days). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts. Conclusions: Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe that a further investigation into this implant complication is warranted. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction: C2 fractures are one of the most common traumatic injuries of the cervical spine, with high rates of morbidity and mortality. Current literature on the incidence of C2 fractures is limited to populations outside of the United States (US), prior to 2014, or specific age cohorts. The purpose of this study is to report the incidence rate (IR) of C2 fractures and associated patient demographics in the US between 2002 and 2021 using the National Electronic Injury Surveillance System (NEISS) database. Methods: This study analyzed the NEISS database to identify cases of C2 fractures presenting to US Emergency Departments (EDs) from 2002 to 2021. Annual and overall numbers of fractures, IR, and patient demographics were analyzed. IR is expressed as the number of fractures per 100,000 person-years at risk (PYR). Patients were split into three different age groups for comparison (children and young adults, 0–64 years; older adults, 65–79 years; elderly individuals, 80 + years). Results: A national estimate of n = 72,764 patients (95% confidence interval [CI] = 54,371–91,156) presented to US EDs with a C2 fracture (IR was 1.17/PYR; 95% CI = 0.87–1.46), and elderly individuals had the highest IR overall (IR = 15.9; P < 0.05). The IR of C2 fractures between 2002 and 2021, reported as average annual percent change (AAPC), increased significantly, regardless of age or sex (AAPC = 10.9; 95% CI = 6.3–15.6; P < 0.0001). Conclusion: C2 fractures occur at higher rates than previous years, with especially high IR in elderly individuals. Emphasis of public health efforts toward osteoporosis and coordination difficulties in elderly individuals would likely significantly reduce the overall IR of these injuries.