Surgical Implant Generation Network (SIGN) intramedullary nailing of open fractures of the tibia

Shah, Ram Kewal; Moehring, H. David; Singh, Ritesh; Dhakal, Anjala

doi:10.1007/s00264-003-0535-9

Cited by 40 publications

(41 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…SIGN currently has greater than 250 sites in more than 50 countries where SIGN nails have become a mainstay of treatment used by local surgeons [14]. The SIGN nails have been approved by the FDA and have shown good clinical results in small clinical series [7,12,13]. The SIGN standard nail was designed and began use in 1999 and is a solid stainless steel nail with a 9°p roximal bend and 1.5°distal bend, offered in 8 mm to 12 mm diameters and 280 mm to 420 mm lengths [14].…”

Section: Introductionmentioning

confidence: 99%

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

Carsen

Park

Simon

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background The burden of orthopaedic trauma in the developing world is substantial and disproportionate. SIGN Fracture Care International is a nonprofit organization that has developed and made available to surgeons in resourcelimited settings an intramedullary interlocking nail for use in the treatment of femoral and tibial fractures. Instrumentation also is donated with the nail. A prospectively populated database collects information on all procedures performed using this nail. Given the challenging settings and numerous surgeons with varied experience, it is important to document adequate alignment and union using the device. Questions/purposes The primary aim of this research was to assess the adequacy of operative reduction of closed diaphyseal femur fractures using the SIGN interlocking intramedullary nail based on radiographic images available in the SIGN database. The secondary aims were to assess correlations between postoperative alignment and several associated variables, including fracture location in the diaphysis, degree of fracture site comminution, and time to surgery. The tertiary aim was to assess the functionality of the SIGN database for radiographic analyses. Methods A review of the prospectively populated SIGN database was performed for patients with a diaphyseal femur fracture treated with the SIGN nail, which at the time of the study totaled 32,362 patients. After study size calculations, a random number generator was used to select 500 femur fractures for analysis. Exclusion criteria included open fractures and those without radiographs during the early postoperative period. The following information was recorded: location of the fracture in the diaphysis; fracture classification (AO/Orthopaedic Trauma Association [OTA] classification); degree of comminution (Winquist and Hansen classification); time from injury to surgery; and patient demographics. Measurements of alignment were obtained from the AP and lateral radiographs with malalignment defined as deformity in either the sagittal or coronal plane greater than 5°. Measurements were made manually by the four study authors using onscreen protractor software and interobserver reliability was assessed. Results The frequency of malalignment greater than 5°o bserved on postoperative radiographs was 51 of 501 (10%; 95% CI, 6.5-11.5), and malalignment greater than Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® 10°occurred in eight of 501 (1.6%) of the femurs treated with this nail. Fracture location in the proximal or distal diaphysis was strongly correlated with risk of malalignment, with an odds ratio (OR) of 3.7 (95% CI, 1.5-9.3) for distal versus middle diaphyseal fractures and an OR of 4.7 (95% CI, 1.9-11.5) for proximal versus middle fractures (p \ 0.001). Time from injury to surgery greater than 4 weeks also was strongly correlated with risk of malalignment (p \ 0.001). Inherent fracture stability, based on fracture site comminution as per the Winquist and Hansen clas...

show abstract

Section: Introductionmentioning

confidence: 99%

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

Carsen

Park

Simon

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…In view of these low figures and the probability that followup cases in the database are biased toward difficult and unexpected outcomes, we suggest the data in the SIGN database itself cannot be used for outcome studies. It is, however, a source of cases that were used for followup studies [15,32,33].…”

Section: Resultsmentioning

confidence: 99%

“…The institutions are resupplied with implants after 20 cases have been submitted to the database. The database has also been used extensively for collecting cases for studies on the union rate and complications of this treatment method [15,32,33]; many other studies have been presented to the annual SIGN conferences or in the country of origin. The December 2009 issue of Techniques in Orthopaedics [44] is devoted to reports about the SIGN surgical system [34].…”

Section: Introductionmentioning

confidence: 99%

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

Clough

Zirkle²,

Schmitt³

2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries. Questions/purposes We describe the information in the SIGN database then address two questions: In the context of the design and implementation of a global trauma database, what lessons does the SIGN database teach? Does the SIGN program have a role in the evolution of a wider global system? Methods The SIGN database is Internet based. After treating a patient with a SIGN nail surgeons enter radiographs and details of the case.

show abstract

“…However, if external fixation is not available, good results have been reported with im nailing of open tibial fractures. 59 …”

Section: Infectionsmentioning

confidence: 99%

Orthopaedic trauma surgery in low-income countries

Young¹

2014

Acta Orthopaedica

View full text Add to dashboard Cite

Surgical Implant Generation Network (SIGN) intramedullary nailing of open fractures of the tibia

Cited by 40 publications

References 24 publications

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

Orthopaedic trauma surgery in low-income countries

Contact Info

Product

Resources

About