Backout of Distal Interlocking Screws after Retrograde Femoral Nailing with a Novel Device – A Case Series

Minhas, Arjun; Berkay, Fehmi; Hudson, Tanner L; Froehle, Andrew W.; Horne, Brandon R.; Orr, Charlotte; Venkatarayappa, Indresh; Jerele, Jennifer

doi:10.1097/bot.0000000000002646

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…There has been 1 previously published report on early distal interlocking screw back out using this device. Minhas et al 4 reported on 27 patients that underwent fracture fixation using the experimental implant and noted screw back out in 8 patients (30%) after an average of 61 days postoperatively. This study demonstrated a comparable rate of screw back out at an average of 3.2 weeks postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures

Cinats,

Bashir,

Toney

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To determine the early implant failure rate of a novel retrograde intramedullary femoral nail METHODS: Design: Retrospective matched case control Setting: Academic level 1 trauma center Patients Selection Criteria: Patients 18 years and older with an acute AO/OTA 32-A, 32-B, 32-C, and 33-A fracture or periprosthetic distal femur fracture from April 2018 to April 2022 were included in the study. The two interventions compared were the Synthes Expert Retrograde/antegrade femoral nail (RAFN or control implant) versus the next generation RFN-Advanced retrograde femoral nail (RFNA or experimental implant) (Synthes, West Chester, PA). Outcome Measures and Comparisons: Early implanted-related complications between the experimental and control implants were assessed including locking screw backout, screw breakage, intramedullary nail failure, need for secondary surgery, and loss of fracture reduction RESULTS: 314 patients were identified with a mean age of 31.0 years and 62.4% of the patients being male. Open fractures occurred in 32.5% of patients with 3.8% of injuries being distal femur periprosthetic fractures. 56 patients in the experimental group and 258 patients in the control group. Mean follow-up was 46.8 weeks for the control cohort and 21.0 weeks for the experimental cohort. Distal interlocking screw backout occurred in 23.2% [13 of 56] of experimental group patients and 1.9% [5 of 258] of control group patients (p<0.0001). Initial diagnosis of interlocking screw back out occurred at an average of 3.2 weeks post-operatively (range, 2-12 weeks). 54% of patients that sustained screw back-out underwent a secondary operation to remove the symptomatic screws (12.5% of all patients treated with the experimental implant required an unplanned secondary operation due to screw backout). A logistic regression model was used to predict screw back out and found the experimental implant group was 4.3 times as likely to experience distal locking screw backout compared to the control group (p=0.01). CONCLUSIONS: The RFNA implant was associated with a significantly higher rate of screw back-out with a substantial number of unplanned secondary surgeries compared to the previous generation of this implant. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…3 Despite these purported benefits, there is concern about early distal locking screw failure. 4 The purpose of this study was to report on the early implant-related outcomes of distal femur fractures treated with retrograde femoral nailing using polymer inlay technology compared with the previous generation of this implant (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures

Cinats,

Bashir,

Toney

et al. 2024

Journal of Orthopaedic Trauma

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Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures

Bhale,

Campbell,

Fitzpatrick

et al. 2024

Eur J Orthop Surg Traumatol

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Purpose The retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors. Methods A retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails. Results One hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3 weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12). Conclusion In this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails.

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Current Concepts in Management of Distal Femur Fractures

Babhulkar,

Trikha,

Babhulkar

et al. 2024

Injury

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Backout of Distal Interlocking Screws after Retrograde Femoral Nailing with a Novel Device – A Case Series

Cited by 4 publications

References 10 publications

Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures

Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures

Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures

Current Concepts in Management of Distal Femur Fractures

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