Outcome of SIGN Nail Initiative in Treatment of Long Bone Fractures in Addis Ababa, Ethiopia

Abstract

Background: Currently the standard of treatment for femoral shaft fracture and unstable tibia fracture are closed locking intramedullary nail which require fluoroscopy and fracture table. The objective of this review was to evaluate the outcome of Surgical Implant Generation Network (SIGN ) initiative, locking intramedullary nailing that do not require fluoroscopy and fracture table, in Ethiopia. Methods: This is prospective descriptive study of 180 fractures of femur and/or tibia, which were openly reduced and fixed using SIGN intramedullary nail and screw. All were followed at least for one year, either until complete rehabilitation or nail removal. Result: Totally 180 fractures of femur and/or tibia in 166 patients were included in the study. There were 127 male and 39 female giving male to female ratio of 3:1. The mean age was 34 years (range 13-88). Road traffic accident (RTA) was the leading cause of injury (75%). The fracture site was 123 femurs and 57 tibias with the fracture pattern of 37% simple, 40% wedge and 23% complex. Twelve pecent were compound fractures. Post operative reduction and nail position was excellent in all case. Majority (90%) started partial weight bearing with crunches with in the first two weeks and their mean hospital stay was 14 days. On average bony union occurred at 7.4 weeks. Majority of knees had at least 130 degree of flexion. The mean duration of follow up and number of visit was 22 month and 5 times respectively. The infection rate was 2.8% and other complications were minimal and acceptable. Conclusion: The union rate and rehabilitation are very satisfactory with low infection rate, minimal malunion, short hospital stay and early mobilization of the patient. This makes SIGN nail the best for all femoral and most tibial fracture fixation in our situation.