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Comparative Study
. 2024 Aug;34(6):2909-2913.
doi: 10.1007/s00590-024-04006-5. Epub 2024 May 28.

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

Rahul Bhale  1 , Sean T Campbell  1 , Ellen Fitzpatrick  1 , Gillian Soles  1 , Mark Lee  1 , Augustine M Saiz Jr  2
Affiliations
Comparative Study

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

Rahul Bhale et al. Eur J Orthop Surg Traumatol. 2024 Aug.

Abstract

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.

Keywords: Distal femur fracture; Femoral nail; Intramedullary nail; Retrograde femoral nail; Retrograde femoral nailing advanced.

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Conflict of interest statement

Author RB declares that he has no conflict of interest. Author STC is a member of an OTA committee. Author EF declares that she has no conflict of interest. Author GS is a member of an OTA committee, AO Trauma North America committee, and is a paid consultant for DePuy Synthes, a Johnson & Johnson company A. Author MAL is a board member of AO Trauma North America, receives IP royalty from Globus Medical, owns stock in Osteocentric, is a paid consultant for Osteocentric, and is a paid consultant for DePuy Synthes, a Johnson & Johnson company. Author AMS is a member of an OTA committee, ORS committee, AAOS committee, and AO North America committee.

Figures

Fig. 1
Fig. 1
Injury AP (a) and lateral (b) radiographs demonstrating a low periprosthetic distal femur fracture adjacent to a knee arthroplasty component. Intraoperative AP (c) and lateral (d) fluoroscopic images following reduction and surgical fixation using the RFNA. Six-week follow-up AP (e) and lateral (f) radiographs demonstrating unchanged alignment and 3.9 mm distal interlock screw back-out (note the lateral to medial distal-most screw position in image (e)
Fig. 2
Fig. 2
Follow-up AP radiograph demonstrating 27.7 mm distal interlock screw back-out four weeks after treatment with RFNA. The alignment remained unchanged
See this image and copyright information in PMC

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