Related Experiment Video
Updated: Feb 11, 2026
Establishment of a Segmental Femoral Critical-size Defect Model in Mice Stabilized by Plate Osteosynthesis
Published on: October 12, 2016
Effect of Insert Material on Interlocking Screw Stability in Retrograde Femoral Nailing: Ultra-High Molecular Weight
Brendan E Page1, M Kareem Shaath1,2,3, Timothy J Baker1
1Orlando Health Jewett Orthopedic Institute, Orlando, FL.
Objectives:
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.
Design:
Retrospective chart review.
Setting:
Single academic, Level-1 Trauma Center.
Patient Selection Criteria:
Included were adult patients (age ≥18 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.
Outcome Measures And Comparisons:
The primary outcome was rate of distal interlocking screw backout. Secondary outcomes included reoperation, infection, and nonunion.
Results:
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 ( P > 0.05). The average age was higher in the PEEK group (63 vs. 48 years; P < 0.001). Screw backout occurred in 3 of 50 fractures (6%) in the UHMWPE group compared with 0 of 63 in the PEEK group ( P = 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 ( P = 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.
Conclusions:
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.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
More Related Videos
04:41Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
08:20A Reliable and Reproducible Critical-Sized Segmental Femoral Defect Model in Rats Stabilized with a Custom External Fixator
Published on: March 24, 2019
Related Concept Videos
01:21Screw: Problem Solving
To evaluate the...
01:16Self-Locking Screw
A square-threaded screw jack carrying a load is considered self-locking if the screw retains its position even after the moment applied to it is removed.
01:05Accessory Structures of the Skin: Nails
The main components of a nail include the following.
Nail Plate: The nail plate is the visible portion of the nail that extends beyond the fingertips or toes. It is a hard, translucent...
01:17Frictional Forces on Screws
A jack with a square-threaded screw is a mechanical device used to lift heavy loads by applying a force at its handle. When the force is applied, the screw turns, raising the load. The screw can...
03:18Nuclear Stability
To hold positively charged protons together...
01:53RNA Stability