{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:55:01Z","timestamp":1791273301928,"version":"4.1.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the rate of distal interlocking screw backout between inlay-design and non-inlay design retrograde intramedullary femoral nails in the treatment of distal femur fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with AO\/OTA 33 distal femur fractures treated with a retrograde ultra-high molecular weight polyethylene (UHMWPE) inlay-design nail (RFNA; DePuy Synthes) or a non-inlay design nail (T2 SCN; Stryker) between January 2015 and June 2025 at a single Level I academic trauma center with a minimum follow-up of 3\u00a0months were retrospectively reviewed. The primary outcome was distal interlocking screw backout. Secondary outcomes included time to backout diagnosis, backout distance, and rate of symptomatic screw removal. All outcomes were compared between the inlay-design and the non-inlay design cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 134 patients were included: 76 in the inlay cohort and 58 in the non-inlay cohort. The inlay cohort demonstrated a significantly lower rate of distal interlocking screw backout compared to the non-inlay cohort (5.3% vs. 19.0%; RR 0.28, 95% CI 0.09\u20130.83;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), corresponding to a 72.2% relative risk reduction. Time to backout diagnosis and backout distance did not differ significantly between designs. The rate of symptomatic screw removal was significantly lower in the inlay cohort (1.3% vs. 10.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). The distal transverse screw was the most common screw with backout in both cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ultra-high molecular weight polyethylene (UHMWPE) inlay at the distal interlocking interface of a retrograde femoral nail was associated with significantly lower rates of distal interlocking screw backout and symptomatic screw removal. When backout did occur, polyethylene inlay did not impact time to diagnosis and backout distance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-026-04983-9","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:40:39Z","timestamp":1791272439000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased screw backout with non\u2013inlay design retrograde femoral nails"],"prefix":"10.1007","volume":"36","author":[{"given":"Benyamin","family":"Dadpey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Sward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Dao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7065-9551","authenticated-orcid":false,"given":"William","family":"Kent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"4983_CR1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/J.INJURY.2006.04.130","volume":"37","author":"CM Court-Brown","year":"2006","unstructured":"Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691\u2013697. https:\/\/doi.org\/10.1016\/J.INJURY.2006.04.130","journal-title":"Injury"},{"key":"4983_CR2","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/S00402-020-03721-Y","volume":"142","author":"R Atzmon","year":"2022","unstructured":"Atzmon R, Drexler M, Ohana N et al (2022) The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery. Arch Orthop Trauma Surg 142:947\u2013953. https:\/\/doi.org\/10.1007\/S00402-020-03721-Y","journal-title":"Arch Orthop Trauma Surg"},{"key":"4983_CR3","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1007\/S00590-021-03140-8\/TABLES\/1","volume":"32","author":"S Nino","year":"2022","unstructured":"Nino S, Parry JA, Avilucea FR et al (2022) Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate. Eur J Orthop Surg Traumatol 32:1577\u20131582. https:\/\/doi.org\/10.1007\/S00590-021-03140-8\/TABLES\/1","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"4983_CR4","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/J.INJURY.2017.01.015","volume":"48","author":"M Hamaker","year":"2017","unstructured":"Hamaker M, O\u2019Hara NN, Eglseder WA et al (2017) Radiographic predictors of symptomatic screw removal after retrograde femoral nail insertion. Injury 48:758\u2013762. https:\/\/doi.org\/10.1016\/J.INJURY.2017.01.015","journal-title":"Injury"},{"key":"4983_CR5","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/J.INJURY.2006.01.005","volume":"37","author":"SK Singh","year":"2006","unstructured":"Singh SK, El-Gendy KA, Chikkamuniyappa C, Houshian S (2006) The retrograde nail for distal femoral fractures in the elderly: high failure rate of the condyle screw and nut. Injury 37:1004\u20131010. https:\/\/doi.org\/10.1016\/J.INJURY.2006.01.005","journal-title":"Injury"},{"key":"4983_CR6","doi-asserted-by":"publisher","first-page":"E207","DOI":"10.1097\/BOT.0000000000002797","volume":"38","author":"ME Cain","year":"2024","unstructured":"Cain ME, Hendrickx LAM, Sierevelt I et al (2024) Rotational malalignment after intramedullary nailing of tibial shaft fractures is predictable. J Orthop Trauma 38:E207\u2013E213. https:\/\/doi.org\/10.1097\/BOT.0000000000002797","journal-title":"J Orthop Trauma"},{"key":"4983_CR7","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/BOT.0000000000002646","volume":"37","author":"A Minhas","year":"2023","unstructured":"Minhas A, Berkay F, Hudson T et al (2023) Backout of distal interlocking screws after retrograde femoral nailing with a novel device: a case series. J Orthop Trauma 37:500\u2013505. https:\/\/doi.org\/10.1097\/BOT.0000000000002646","journal-title":"J Orthop Trauma"},{"key":"4983_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/J.INJURY.2025.112227","volume":"56","author":"AL Vlasak","year":"2025","unstructured":"Vlasak AL, Palm LS, Hagen JE et al (2025) Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: a retrospective review. Injury 56:112227. https:\/\/doi.org\/10.1016\/J.INJURY.2025.112227","journal-title":"Injury"},{"key":"4983_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000003043","author":"AN Musick","year":"2025","unstructured":"Musick AN, Wagner RK, Kraus KM et al (2025) Distal interlocking screw backout in new-generation retrograde femoral nails. J Orthop Trauma. https:\/\/doi.org\/10.1097\/BOT.0000000000003043","journal-title":"J Orthop Trauma"},{"key":"4983_CR10","doi-asserted-by":"publisher","first-page":"2909","DOI":"10.1007\/S00590-024-04006-5\/FIGURES\/2","volume":"34","author":"R Bhale","year":"2024","unstructured":"Bhale R, Campbell ST, Fitzpatrick E et al (2024) Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures. Eur J Orthop Surg Traumatol 34:2909\u20132913. https:\/\/doi.org\/10.1007\/S00590-024-04006-5\/FIGURES\/2","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"4983_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/J.INJURY.2025.112265","volume":"56","author":"D Piper","year":"2025","unstructured":"Piper D, Qatawneh AA, Grazette A et al (2025) Distal locking screw migration in the depuy-synthes retrograde femoral nail-advanced\u2014an unexpected consequence of an implant upgrade. Injury 56:112265. https:\/\/doi.org\/10.1016\/J.INJURY.2025.112265","journal-title":"Injury"},{"key":"4983_CR12","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/BOT.0000000000002804","volume":"38","author":"DJ Cinats","year":"2024","unstructured":"Cinats DJ, Bashir A, Toney CB et al (2024) Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures. J Orthop Trauma 38:333\u2013337. https:\/\/doi.org\/10.1097\/BOT.0000000000002804","journal-title":"J Orthop Trauma"},{"key":"4983_CR13","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1097\/BOT.0000000000002979","volume":"39","author":"DM Alcaide","year":"2025","unstructured":"Alcaide DM, Blackwood N, Arthur R et al (2025) Distal interlock backout in the advanced retrograde femoral nailing system (RFNA) in femur fractures: short-term outcome analysis. J Orthop Trauma 39:357\u2013361. https:\/\/doi.org\/10.1097\/BOT.0000000000002979","journal-title":"J Orthop Trauma"},{"key":"4983_CR14","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1051\/SICOTJ\/2024016","volume":"10","author":"G Saraglis","year":"2024","unstructured":"Saraglis G, Khan A, Sharma A et al (2024) The linked nail\/plate construct for the management of distal femur fractures in the elderly. SICOT J 10:20. https:\/\/doi.org\/10.1051\/SICOTJ\/2024016","journal-title":"SICOT J"},{"key":"4983_CR15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.5606\/EHC.2015.06","volume":"26","author":"O Ba\u015fci","year":"2015","unstructured":"Ba\u015fci O, Karaka\u015fli A, Kumtepe E et al (2015) Combination of anatomical locking plate and retrograde intramedullary nail in distal femoral fractures: comparison of mechanical stability. Eklem Hastalik Cerrahisi 26:21\u201326. https:\/\/doi.org\/10.5606\/EHC.2015.06","journal-title":"Eklem Hastalik Cerrahisi"},{"key":"4983_CR16","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1007\/S00590-025-04239-Y\/FIGURES\/4","volume":"35","author":"M Daher","year":"2025","unstructured":"Daher M, Parsons A, Mauffrey C, Richard R (2025) Nail-plate combination versus single construct for the management of distal femoral fractures: a meta-analysis. Eur J Orthop Surg Traumatol 35:124. https:\/\/doi.org\/10.1007\/S00590-025-04239-Y\/FIGURES\/4","journal-title":"Eur J Orthop Surg Traumatol"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04983-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-026-04983-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04983-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:40:40Z","timestamp":1791272440000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-026-04983-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4983"],"URL":"https:\/\/doi.org\/10.1007\/s00590-026-04983-9","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"20 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflict of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"401"}}