Sekimpi P., Okike K., Zirkle L., Jawa A.
Department of Orthopaedics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda; Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Surgical Implant Generation Network, 451 Hills Street, Richland, WA 99354, United States; Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, 2 North, 850 Harrison Avenue, Boston, MA 02118, United States
Sekimpi, P., Department of Orthopaedics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda; Okike, K., Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Zirkle, L., Surgical Implant Generation Network, 451 Hills Street, Richland, WA 99354, United States; Jawa, A., Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, 2 North, 850 Harrison Avenue, Boston, MA 02118, United States
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. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.
adolescent; adult; aged; article; controlled clinical trial; controlled study; developing country; diaphysis; female; femur shaft fracture; follow up; fracture fixation; fracture healing; fracture nonunion; human; interlocking nail; intramedullary nail; intramedullary nailing; joint characteristics and functions; leg length inequality; length of stay; major clinical study; male; open reduction; outcome assessment; patella fracture; postoperative infection; priority journal; real time echography; retrospective study; traction therapy; traffic accident; Uganda; Adolescent; Adult; Aged; Bone Nails; Developing Countries; Female; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Male; Middle Aged; Reoperation; Retrospective Studies; Treatment Outcome; Uganda; Young Adult