Turner EHG, Javid K, Fitzgerald KL, Brennan B, Hakeos WM, Maier LM, Hoegler J, Guthrie ST. Impact of fracture patterns and patient factors on distal interlocking screw backout after retrograde femoral nailing. World J Orthop 2026; 17(5): 118601 [DOI: 10.5312/wjo.v17.i5.118601]
Corresponding Author of This Article
Kashif Javid, Department of Orthopaedic Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, United States. kjavid1@hfhs.org
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2026; 17(5): 118601 Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.118601
Impact of fracture patterns and patient factors on distal interlocking screw backout after retrograde femoral nailing
Elizabeth H G Turner, Kashif Javid, Kate L Fitzgerald, Benjamin Brennan, William M Hakeos, Lindsay M Maier, Joseph Hoegler, Stuart T Guthrie
Elizabeth H G Turner, Kashif Javid, Kate L Fitzgerald, William M Hakeos, Lindsay M Maier, Joseph Hoegler, Stuart T Guthrie, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI 48202, United States
Benjamin Brennan, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, United States
Author contributions: Turner EHG, Javid K, and Fitzgerald KL drafted the initial draft of the manuscript; Turner EHG and Fitzgerald KL conceptualized, designed, and were responsible for data collection for the study; Brennan B was responsible for statistical analysis; Hakeos WM, Maier LM, Hoegler J, and Guthrie ST supervised the project, performed formal analysis, and provided key revisions to the manuscript; all authors contributed to manuscript review and editing and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Henry Ford Health System.
Informed consent statement: The study was conducted as a retrospective chart review in accordance with institutional policies and applicable regulations. The requirement for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Kashif Javid, Department of Orthopaedic Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, United States. kjavid1@hfhs.org
Received: January 12, 2026 Revised: February 23, 2026 Accepted: April 20, 2026 Published online: May 18, 2026 Processing time: 132 Days and 3 Hours
Abstract
BACKGROUND
Retrograde femoral nailing is a common procedure done to treat native or periprosthetic distal femur fractures. Among intramedullary devices, the DePuy Synthes Retrograde Femoral Nail-Advanced Retrograde Femoral Nailing System is one such newer intervention that claims features that improve implant alignment and distal fixation. However, previous studies evaluating interlock screw backout in this implant have demonstrated varying backout rates.
AIM
To evaluate factors associated with distal interlocking screw backout after using the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA, United States). We hypothesize that higher backout rates might be observed in older patients with medical comorbidities that can affect bone quality, such as smoking and diabetes, and in fracture patterns that may put higher strain on the distal fixation.
METHODS
A retrospective case control study was performed on patients undergoing retrograde femoral nailing from 2021 to 2024 at an academic level 1 trauma center through electronic medical record review. The cohort was stratified into those with distal interlocking screw backout and those without. Categorical outcomes were compared using χ2 tests and continuous outcomes were compared with nonparametric tests. Significance was determined as P < 0.1, and variables that differed between groups at this level were included in a subsequent logistic regression model.
RESULTS
A total of 76 patients met inclusion criteria, with 9 patients (11.8%) experiencing distal interlocking screw backout and 67 patients (88.2%) not experiencing backout. The average age of our patients was 41.8 years old. The cohort with distal interlocking screw backout had a statistically significant higher median age compared to the non-backout group, 68 years vs 38 years (P = 0.011). Both anterior-posterior (AP) and lateral (LAT) distance to the fracture were significant at P < 0.1. Distance on the LAT view was 76 mm [interquartile range (IQR): 54-98] for the failure group compared to 120 mm (IQR: 63-180) for the non-failure group (P = 0.052). Distance on the AP view was 63 mm (IQR: 56-80) for the failure group compared to 123 mm (IQR: 61-181) for the non-failure group (P = 0.064).
CONCLUSION
Age and distance to the fracture line from the joint line on AP and LAT radiographs were significantly different between the two cohorts. Further biomechanical testing could be utilized to determine the forces present on the distal interlocking screws with varying fracture patterns.
Core Tip: The purpose of our study was to evaluate patient and fracture-related factors associated with distal interlocking screw backout after retrograde femoral nailing with the DePuy Synthes Retrograde Femoral Nail-Advanced Retrograde Femoral Nailing System. Older age was significantly associated with higher rates of screw backout, with affected patients averaging 68 years compared to 38 years in the non-backout group. Fracture lines located closer to the joint line on both anterior-posterior and lateral radiographs were associated with increased risk of screw backout. No significant associations were found between screw backout and comorbidities such as smoking, diabetes, or body mass index. These findings suggest that certain fracture patterns and older patients may require careful consideration when using the DePuy Synthes Retrograde Femoral Nail-Advanced Retrograde Femoral Nailing System device.
