Surgical Implant Generation Network (SIGN) Solid Intramedullary Interlocking Nail in the Lower Extremity: An Observational Study from Western Nepal 1614-1617
Manoj Kumar Chakraborty
Prof&HOD, Orthopedics Department, Manipal College of
Medical Sciences, Pokhara, Nepal.
Background: Intramedullary nail fixation has become the standard of treatment for both femoral and tibial shaft fractures. It functions as internal splints that allow secondary fracture healing. The axial and rotational stability of the conventional hollow interlocking nails depends primarily on the locking screws. Surgical Implant Generation Network (SIGN) was formed in 1999, with the vision of creating an equality of fracture care throughout the world. This system has been utilized at a variety of facilities in low income countries throughout the world.
Objective: To evaluate the efficacy of SIGN nailing in the long bones of the lower extremity.
Method and Materials: This was a hospital based, retrospective study which was conducted in the Orthopedics Department of the Manipal College of Medical Sciences, Pokhara, Nepal between May, 2010 and August, 2011. A total of 24 cases with fractures of the femur and the tibia were studied. Both closed and open types of fractures were included and the fracture fixation was done by using SIGN interlocking solid nails and instrumentation. The analysis was done by using descriptive statistics and the testing of the hypothesis. The data was analyzed by using Excel 2003, the Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version.
Results: Out of the 24 patients, 16 (66.7%) were males and 8 (33.3%) were females. The average age of the patients was 29.58, with a range of 13-60 years. An intramedullary interlocking SIGN nail was performed in 18 (75%) tibial and 6 (25 %) femoral fractures, with 41.7 % being right sided and 58.3% being left sided. The types of fractures which were included were closed= 66.67 % and open fractures= 33.33%. According to the Gustilo- Anderson classification, 4.17 % were Gustilo I, 25 % were Gustilo II and 4.17 % were Gustilo III a. Open reduction was done in 58.3 % and closed reduction was done in 41.7 % of the cases. Reaming was done in all the cases and no post-operative infections were noted. There was a significant relationship between the type of fracture and factors like the affected side, the method of the fracture reduction and the location of the fracture.
Conclusion: The SIGN solid intramedullary interlocking nail shows promising results in comparison to the hollow nail because of its better strength, better accuracy in distal locking and surprisingly better results in infection and non-union