Venture Forth: The SIGN Nail

There aren't too many organizations that get me excited about what they are doing like SIGN Fracture Care International. www.signfracturecare.org. Surgical Implant Generation Network (SIGN) was begun just over a decade ago by Dr Lewis Zirkle, an orthopedic surgeon in eastern Washington with a big heart and an even larger vision of "creating equality of fracture care throughout the world," particularly the poor.

Trauma is rampant in developing countries and with over 5 million people killed annually in road traffic crashes (RTCs), it has rightly been named the "neglected epidemic." Many more than that experience permanent disability. The majority of people affected by RTCs are young males, often the financial providers of their families in developing countries. The impact of a femoral shaft fracture - the most common musculoskeletal injury seen - is immense not only in the pain and recovery endured by the patient but the economic burden borne by the patient's family. The mainstay of treatment for femoral shaft fractures in developing settings is traction. For those that don't know, a traction pin (basically a metal pin roughly the size of a pencil) is placed through the unbroken tibia and then weight is hung via a rope off the end of the bed. The patient lies in bed for roughly 6-8 weeks in hopes that the weight has realigned the bones good enough to heal straight. Too often this does not happen. Too often the fracture heals crooked (Malunion), doesn't heal at all (Nonunion), or becomes infected via the traction pin (Osteomyelitis). Here in the US and other developed countries the mainstay of treatment is a femoral nail - a large rod placed down the middle of the bone - that allows early mobililty, weight-bearing, and far superior alignment and union rates. Until the SIGN nail, such technology was reserved for the wealthy (i.e. Us). The SIGN nail has literally revolutionized the way long bone fractures (femur, tibia, humerus) are treated around the world.

Case in Point: Femoral Malunion

25 year old male with Right Segmental Femoral Shaft Fracture sustained in a RTC. He was treated at an outside hospital for 6 weeks in tibial skeletal traction and presented to Tenwek Hospital 2 months post injury with his right leg 5+ inches shorter than his left leg and externally rotated with significant pain.

Postop of Same Patient: Antegrade SIGN Nail with Clamshell Osteotomy

As of today, over 110,000 nails have been placed in over 300 hospitals throughout 50+ countries around the world. The nail is a solid, stainless steel nail that does not require power instrumentation, real-time x-ray imaging (fluoroscopy), or special fracture tables, all of which are typically utilized here in the USA. The nail has proximal and distal interlocking screw capabilities with a ingeniously engineered means of placing the screws. The same nail can be placed in both the tibia and femur. And the nail is completely FREE to the patient! Attention continues to be focused on international orthopedic work and SIGN is uniquely positioned to empower and equip surgeons all over the world to work toward Dr Zirkle's dream of fracture care equality.

We used the SIGN nail multiple times while I was in Kenya. My first case there at Tenwek was a retrograde SIGN nail on a young 25 year old man with a femoral shaft fracture after a RTC. Since Dr Galat arrived a few years ago, over 600 nails have been placed at Tenwek Hospital.