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Femoral Fracture Fixation in Developing Countries: An Evaluation of the Surgical Implant Generation Network (SIGN) Intramedullary Nail

Sekimpi, Patrick MD; Okike, Kanu MD, MPH; Zirkle, Lewis MD; Jawa, Andrew MD

Journal of Bone & Joint Surgery - American Volume: 5 October 2011 - Volume 93 - Issue 19 - p 1811–1818
doi: 10.2106/JBJS.J.01322
Scientific Articles

Background: The Surgical Implant Generation Network (SIGN) intramedullary nailing system was designed to treat femoral fractures in developing countries where real-time imaging, power equipment, and fracture tables are often not available. We performed a retrospective analysis of prospectively collected data on femoral shaft fractures treated with the SIGN intramedullary nailing system.

Methods: Seventy consecutive patients with a closed diaphyseal femoral fracture were treated with the SIGN intramedullary nail at Mulago National Hospital in Uganda between February 2007 and March 2008, and fifty of these patients (the study cohort) were followed for at least six months or until fracture-healing.

Results: The mean time to surgery was 13.2 days (range, zero to thirty-three days). All fractures healed, although two required dynamization for treatment of delayed union. No hardware failures occurred. An interlocking screw missed the nail in two patients, but both fractures healed without complications. One superficial and one deep infection developed; the latter required nail removal after fracture union. Including these patients, complications requiring further treatment occurred in 14% (seven) of the fifty patients.

Conclusions: The SIGN intramedullary nailing system promotes predictable healing of femoral fractures in settings with limited resources including lack of real-time imaging, lack of power reaming, and delayed presentation to the operating room.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopaedics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda

2Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114

3Surgical Implant Generation Network, 451 Hills Street, Suite B, Richland, WA 99354

4Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, Dowling Building, 2 North, 850 Harrison Avenue, Boston, MA 02118

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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