{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:51:24Z","timestamp":1791204684971,"version":"4.2.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Subtrochanteric (ST) fractures are proximal femur fractures with strong deforming muscular forces, which complicate anatomical reduction and treatment. These fractures are fixed with intramedullary nails with 2 distal locking screws, although the need for both screws has never been researched.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study's purpose was to investigate the use of 1 versus 2 distal locking screws on clinical and radiographic outcomes and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design\/Level of Evidence:<\/jats:title>\n                    <jats:p>Retrospective cohort, Level of Evidence III.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An IRB-approved retrospective review of a consecutive series of ST femoral fractures was performed. Each patient's medical record was reviewed for demographics, injury and treatment information, perioperative details, radiographic parameters, hospital quality measures, and outcomes. Patients were divided into 2 cohorts: 1 distal locking screw (1-screw cohort) and 2 distal locking screws (2-screw cohort). Distal screw number (1 vs. 2 screws) was chosen by surgeon preference. Comparative and multivariable analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Two hundred thirty-two patients met inclusion criteria with a mean age of 71.18 \u00b1 19.05 years and average follow-up of 11 months. All fractures were treated with a long antegrade, reamed cephalomedullary nail. Fifty (21.6%) patients were fixed with one 5 mm distal locking screw, and 182 (78.4%) patients had 2 screws. Patients with 1 screw had a shorter operative time in minutes (156.64 \u00b1 47.06 vs. 176.06 \u00b1 41.32,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005), but there were no further perioperative differences. Patients treated with 1 screw were more frequently associated with being fixed in a valgus coronal alignment (20% 1 distal screw vs. 5% 2 distal screws,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003) and had higher degree of apex anterior angulation (19.7\u00b0 \u00b1 8.2\u00b0 1-screw vs. 10.6\u00b0 \u00b1 6.3\u00b0 2-screw,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .011). However, this did not significantly affect healing outcomes because both cohorts experienced similar rates of fracture healing, medical and mechanical complications, mortality, and readmission (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .050).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Clinically, a single distal locking bolt is sufficient for ST femur fractures fixed with a cephalomedullary nail. A second distal locking screw may be reserved for situations in which the first screw may not have achieved adequate fixation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bh9.0000000000000058","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:00:38Z","timestamp":1790622038000},"page":"129-134","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Cephalomedullary nail fixation of subtrochanteric femur fractures in older adults: Is 1 distal locking screw enough?"],"prefix":"10.1097","volume":"84","author":[{"given":"Manasa L.","family":"Kadiyala","sequence":"first","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8285-2807","authenticated-orcid":false,"given":"Lauren A.","family":"Merrell","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Ganta","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York"},{"name":"Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8488-2677","authenticated-orcid":false,"given":"Sanjit R.","family":"Konda","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York"},{"name":"Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Rivero","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0341-7683","authenticated-orcid":false,"given":"Kenneth A.","family":"Egol","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New 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One"},{"issue":"suppl 1","key":"R8-20261005","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1016\/S0020-1383(13)70017-2","article-title":"Subtrochanteric fracture non-unions with implant failure managed with the \u201cDiamond\u201d concept","volume":"44","author":"Giannoudis","year":"2013","journal-title":"Injury"},{"key":"R9-20261005","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1302\/2058-5241.5.190045","article-title":"Distal interlocking for short trochanteric nails: static, dynamic or no locking? 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A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures","volume":"27","author":"Gallagher","year":"2013","journal-title":"J Orthop Trauma"},{"key":"R13-20261005","doi-asserted-by":"crossref","first-page":"38613","DOI":"10.52965\/001c.38613","article-title":"Subtrochanteric femoral fractures: a case series of 194 patients treated with long and short intramedullary nails","volume":"14","author":"Jannelli","year":"2022","journal-title":"Orthop Rev (Pavia)"},{"key":"R14-20261005","doi-asserted-by":"crossref","first-page":"211","DOI":"10.12671\/jkfs.2019.32.4.211","article-title":"Failure of intramedullary nailing for subtrochanteric atypical femoral fractures caused by endosteal cortical thickening","volume":"32","author":"Roh","year":"2019","journal-title":"J Korean Fracture Soc"},{"issue":"suppl 1","key":"R15-20261005","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R16-20261005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.1998","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research","volume":"29","author":"Shane","year":"2014","journal-title":"J Bone Miner Res"},{"key":"R17-20261005","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00005373-199502000-00011","article-title":"Femoral torsion after interlocked nailing of unstable femoral fractures","volume":"38","author":"Tornetta","year":"1995","journal-title":"J Trauma"},{"key":"R18-20261005","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/BTO.0000000000000402","article-title":"Technique for guiding distal locking screws into intramedullary nails","volume":"36","author":"Stevens","year":"2019","journal-title":"Tech Orthop"},{"key":"R19-20261005","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1302\/2633-1462.210.BJO-2021-0071.R1","article-title":"Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard","volume":"2","author":"Plumarom","year":"2021","journal-title":"Bone Jt Open"},{"key":"R20-20261005","doi-asserted-by":"crossref","first-page":"519","DOI":"10.2106\/00004623-199304000-00007","article-title":"The use of one compared with two distal screws in the treatment of femoral shaft fractures with interlocking intramedullary nailing. 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