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The Journal of Bone & Joint Surgery, Volume 93, Issue 19 Print
Scientific Articles | October 05, 2011
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Femoral Fracture Fixation in Developing Countries: An Evaluation of the Surgical Implant Generation Network (SIGN) Intramedullary Nail Patrick Sekimpi, MD1; Kanu Okike, MD, MPH2; Lewis Zirkle, MD3; Andrew Jawa, MD4
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1 Department of Orthopaedics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda 2 Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 3 Surgical Implant Generation Network, 451 Hills Street, Suite B, Richland, WA 99354 4 Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, Dowling Building, 2
North, 850 Harrison Avenue, Boston, MA 02118 The Journal of Bone & Joint Surgery. 2011; 93:1811-1818 doi:10.2106/JBJS.J.01322 text A A A
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Abstract
Spica Casting for Pediatric Femoral Fractures: A Prospective, Randomized Controlled Study of Single-Leg Versus Double-Leg Spica Casts J Bone Joint Surg Am. 2012; 94:1259-1264 doi:10.2106/JBJS.K.00966 Socioeconomic Implications of Spica Casting: Commentary on an article by Dirk Leu, MD, et al.: “Spica Casting for Pediatric Femoral Fractures. A Prospective, Randomized Controlled Study of Single-Leg Versus Double-Leg Spica Casts” J Bone Joint Surg Am. 2012; 94:e107 1-2 doi:10.2106/JBJS.L.00500 View More
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.
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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.
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Level of Evidence:
Trauma
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Topics developing countries ; femoral fractures ; fracture fixation, intramedullary ; femoral shaft fracture ; intramedullary nailing ; intramedullary rods
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References Accreditation Statement These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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The Journal of Bone and Joint Surgery 20 Pick ering Street Needham , MA 02492 USA O nline ISSN: 1535-1386 Copyright © 2012. All Rights Reserved. The Journal of Bone and Joint Surgery, Inc.
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