{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:13:14Z","timestamp":1778850794578,"version":"3.51.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To compare short-term implant complications between 2 iterations of the Retrograde Femoral Nailing System Advanced (DePuy Synthes, Raynham, MA), specifically evaluating interlocking screw backout in constructs using ultra-high molecular weight polyethylene (UHMWPE) versus polyetheretherketone (PEEK) distal inserts.<\/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 chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Single academic, Level-1 Trauma Center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>Included were adult patients (age \u226518 years) who underwent retrograde femoral nailing for AO\/OTA type 32 or 33 fractures between July 2024 and July 2025 with at least 3-month follow-up. The UHMWPE insert was used until December 2024; the PEEK insert was implemented system-wide beginning January 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>The primary outcome was rate of distal interlocking screw backout. Secondary outcomes included reoperation, infection, and nonunion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 109 patients (113 fractures) met inclusion criteria: 50 fractures in the UHMWPE group [28 males (61%)] and 63 in the PEEK group [32 males (50%)]. There were no significant differences in sex, body mass index, diabetes, smoking status, or fracture pattern distribution between groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). The average age was higher in the PEEK group (63 vs. 48 years;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Screw backout occurred in 3 of 50 fractures (6%) in the UHMWPE group compared with 0 of 63 in the PEEK group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04). Two of the 3 patients with backout in the UHMWPE group required reoperation. There were 2 (4%) nonunions in the UHMWPE group and none in the PEEK group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.11). All fractures in the PEEK group went on to union without evidence of screw backout or nonunion. There was one infection in the PEEK group requiring irrigation and debridement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The use of a PEEK insert in the Retrograde Femoral Nailing System Advanced system was associated with favorable early outcomes, including the absence of interlocking screw backout compared with the original UHMWPE insert. These findings support the effectiveness of the design modification and may guide implant selection in femoral fracture fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003154","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T14:00:47Z","timestamp":1770732047000},"page":"324-328","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Insert Material on Interlocking Screw Stability in Retrograde Femoral Nailing: Ultra-High Molecular Weight Polyethylene Versus Polyetheretherketone"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3128-6721","authenticated-orcid":false,"given":"Brendan E.","family":"Page","sequence":"first","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4171-0434","authenticated-orcid":false,"given":"Kareem M.","family":"Shaath","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"},{"name":"University of Central Florida College of Medicine, Orlando, FL; and"},{"name":"Florida State University College of Medicine, Orlando, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J.","family":"Baker","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0218-5024","authenticated-orcid":false,"given":"Griffin R.","family":"Rechter","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Casin","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan P.","family":"Yawman","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"},{"name":"University of Central Florida College of Medicine, Orlando, FL; and"},{"name":"Florida State University College of Medicine, Orlando, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"},{"name":"University of Central Florida College of Medicine, Orlando, FL; and"},{"name":"Florida State University College of Medicine, Orlando, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua R.","family":"Langford","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"},{"name":"University of Central Florida College of Medicine, Orlando, FL; and"},{"name":"Florida State University College of Medicine, Orlando, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0193-0969","authenticated-orcid":false,"given":"George J.","family":"Haidukewych","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute, Orlando, FL;"},{"name":"University of Central Florida College of Medicine, Orlando, FL; and"},{"name":"Florida State University College of Medicine, Orlando, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20260515","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/00003086-198809000-00033","article-title":"Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984","author":"Arneson","year":"1988","journal-title":"Clin Orthop Relat Res"},{"key":"R2-20260515","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":"R3-20260515","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1097\/TA.0b013e31828c3dc9","article-title":"Population-based epidemiology of femur shaft fractures","volume":"74","author":"Enninghorst","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"R4-20260515","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2174\/1874325001711011277","article-title":"The epidemiology of adult distal femoral shaft fractures in a central London major trauma centre over five years","volume":"11","author":"Khan","year":"2017","journal-title":"Open Orthop J"},{"key":"R5-20260515","doi-asserted-by":"crossref","first-page":"2675","DOI":"10.1007\/s00264-018-3864-4","article-title":"Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis","volume":"42","author":"Koso","year":"2018","journal-title":"Int Orthop"},{"key":"R6-20260515","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00590-022-03337-5","article-title":"The geriatric distal femur fracture: nail, plate or both?","volume":"33","author":"Wilson","year":"2023","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R7-20260515","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1097\/BOT.0000000000001332","article-title":"Nail plate combination technique for native and periprosthetic distal femur fractures","volume":"33","author":"Liporace","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R8-20260515","first-page":"443","article-title":"Distal femoral fixation: a biomechanical comparison of trigen retrograde intramedullary (i.m.) nail, dynamic condylar screw (DCS), and locking compression plate (LCP) condylar plate","volume":"66","author":"Heiney","year":"2009","journal-title":"J Trauma"},{"key":"R9-20260515","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/BOT.0000000000000784","article-title":"Interprosthetic and peri-implant fractures: principles of operative fixation and future directions","volume":"31","author":"Liporace","year":"2017","journal-title":"J Orthop Trauma"},{"key":"R10-20260515","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s00590-025-04365-7","article-title":"Retrograde nail\/plate combination for interprosthetic femoral fractures: technical note and case series","volume":"35","author":"Shaath","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R11-20260515","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1007\/s00590-021-03140-8","article-title":"Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate","volume":"32","author":"Nino","year":"2022","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R12-20260515","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/00005131-200103000-00003","article-title":"Retrograde versus antegrade nailing of femoral shaft fractures","volume":"15","author":"Ricci","year":"2001","journal-title":"J Orthop Trauma"},{"key":"R13-20260515","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1097\/BOT.0000000000002899","article-title":"Clinical and radiographic results of a retrograde nail-washer combination versus lateral locked plating for distal femur fractures","volume":"38","author":"Shaath","year":"2024","journal-title":"J Orthop Trauma"},{"key":"R14-20260515","doi-asserted-by":"crossref","DOI":"10.1097\/BOT.0000000000002979","article-title":"Distal interlock backout in the RFN-advanced retrograde femoral nailing system (RFNA) in femur fractures: short term outcome analysis","author":"Alcaide","year":"2025","journal-title":"J Orthop Trauma"},{"key":"R15-20260515","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1007\/s00590-024-04006-5","article-title":"Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures","volume":"34","author":"Bhale","year":"2024","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R16-20260515","doi-asserted-by":"crossref","first-page":"112442","DOI":"10.1016\/j.injury.2025.112442","article-title":"Comparison of the RFN-advanced femoral nailing system versus locked lateral plating in the management of distal femur fractures: a matched-cohort analysis","volume":"56","author":"Gilbert","year":"2025","journal-title":"Injury"},{"key":"R17-20260515","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1097\/BOT.0000000000002646","article-title":"Backout of distal interlocking screws after retrograde femoral nailing with a novel device: a case series","volume":"37","author":"Minhas","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R18-20260515","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/BOT.0000000000003043","article-title":"Distal interlocking screw backout in new-generation retrograde femoral nails","volume":"39","author":"Musick","year":"2025","journal-title":"J Orthop Trauma"},{"key":"R19-20260515","doi-asserted-by":"crossref","first-page":"112265","DOI":"10.1016\/j.injury.2025.112265","article-title":"Distal locking screw migration in the depuy-synthes retrograde femoral nail-advanced-an unexpected consequence of an implant upgrade","volume":"56","author":"Piper","year":"2025","journal-title":"Injury"},{"key":"R20-20260515","doi-asserted-by":"crossref","first-page":"112227","DOI":"10.1016\/j.injury.2025.112227","article-title":"Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: a retrospective review","volume":"56","author":"Vlasak","year":"2025","journal-title":"Injury"},{"issue":"suppl 1","key":"R21-20260515","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification Compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R22-20260515","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/BOT.0000000000002804","article-title":"Early complications of a novel retrograde intramedullary femoral nail in the treatment of femur fractures","volume":"38","author":"Cinats","year":"2024","journal-title":"J Orthop Trauma"},{"key":"R23-20260515","doi-asserted-by":"crossref","first-page":"323","DOI":"10.3390\/polym12020323","article-title":"Ultra-high-molecular-weight-polyethylene (UHMWPE) as a promising polymer material for biomedical applications: a concise review","volume":"12","author":"Hussain","year":"2020","journal-title":"Polym (Basel)"},{"key":"R24-20260515","doi-asserted-by":"crossref","first-page":"4845","DOI":"10.1016\/j.biomaterials.2007.07.013","article-title":"PEEK biomaterials in trauma, orthopedic, and spinal implants","volume":"28","author":"Kurtz","year":"2007","journal-title":"Biomaterials"},{"key":"R25-20260515","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jmbbm.2018.03.029","article-title":"Material properties of ultra-high molecular weight polyethylene: comparison of tension, compression, nanomechanics and microstructure across clinical formulations","volume":"83","author":"Malito","year":"2018","journal-title":"J Mech Behav Biomed Mater"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:01:37Z","timestamp":1778850097000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003154","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-01-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}