{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:42:54Z","timestamp":1791315774762,"version":"4.3.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","funder":[{"DOI":"10.13039\/100008127","name":"DePuy Synthes","doi-asserted-by":"crossref","award":["#DPS-TCMF-2021-050"],"award-info":[{"award-number":["#DPS-TCMF-2021-050"]}],"id":[{"id":"10.13039\/100008127","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To examine rate of distal screw backout in patients treated with the DePuy Synthes retrograde femoral nail advanced (RFNA) system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Single Level I Trauma Center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>Adults with types 32 and 33 AO\/OTA femur fractures that underwent fixation between 2021 and 2024 with the RFNA. Patients were included only if they had healed fractures or demonstrated distal screw backout regardless of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>Demographics, injury characteristics, fixation construct, complications such as rates of reoperation, interlock fracture, implant removal, distal screw backout \u22655 mm, and reoperation to promote bone healing were analyzed. Characteristics of patients with and without distal screw backout \u22655 mm were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 101 patients underwent fixation with RFNA for femur fractures. The mean patient age was of 40.4 years (18\u201383), 62.4% were men, and mean body mass index was 29.2. The average follow-up was 281 days (27\u20131041 days). Motor vehicle accident was the most common mechanism of injury (48.5%). Fractures consisted of 77.2% AO\/OTA type 32 and 22.8% type 33. Nine patients (8.9%) had screw backout [mean 15.5 mm (5\u201331 mm)]. Among these, 55.6% were AO\/OTA 32 and 44.4% were AO\/OTA 33. No patients had multiple screws backout. The mean time for diagnosis of screw backout was 73.3 days (25\u2013180 days). Five of 9 patients with backout underwent a reoperation for screw removal because of symptomatic prominence. There was a 5.0% reoperation rate to promote bone healing, a 5.0% surgical site infection rate, and a 3.0% interlock fracture rate. Excluding patients with supplemental fixation, 4 patients (5.7%) had distal screw backout with 2 patients undergoing removal of screw and all achieving union. No significant differences in age (37.5 vs. 35.6;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.821), body mass index (31.5 vs. 29.4;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.607), weightbearing status (weightbearing as tolerated 75% vs. 66.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.134), or distance from fracture to screw (121 vs. 132 mm;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.804) were observed between patients with and without backout.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>When used for treating distal femoral and femoral shaft fractures, the Depuy Synthes RFNA showed an 8.9% rate for distal interlock screw backout \u22655 mm and a 5% reoperation rate for removal of distal screw backout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000002979","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T17:34:43Z","timestamp":1743701683000},"page":"357-361","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Distal Interlock Backout in the Advanced Retrograde Femoral Nailing System (RFNA) in Femur Fractures: Short-Term Outcome Analysis"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-9585","authenticated-orcid":false,"given":"Doriann M.","family":"Alcaide","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Blackwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Arthur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Patch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Rutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clay A.","family":"Spitler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250613","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"key":"R2-20250613","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.otsr.2012.10.014","article-title":"Distal femur fractures. 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