Use of the SIGN IM nail system to stabilize tibiotalocalcaneal arthrodesis in two African hospital settings.

OBJECTIVES: To determine the effectiveness and describe the technique of using the Surgical Implant Generation Network (SIGN) nail to augment tibiotalocalcaneal (TTC) arthrodesis in the developing world. DESIGN: Retrospective review of the SIGN database and description of surgical technique. SETTING: Two centers in rural Kenya, East Africa. PATIENTS: Fifty-seven patients with ankle/hindfoot arthritis or severe trauma. We were able to follow 17 through complete arthrodesis. INVENTION: TTC arthrodesis stabilized with SIGN nail. MAIN OUTCOME MEASURE: Radiographic arthrodesis and return to function. RESULT: Of the patients with significant follow-up, arthrodesis occurred in an average of 19.3 ±â€Š7.5 weeks from the date of surgery. CONCLUSIONS: Recognizing the obstacles to follow-up, the SIGN nail placed with the Herzog curve apex posterior is shown to be an effective device to stabilize a TTC arthrodesis in a limited subgroup of patients with full follow-up.

Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries.

OBJECTIVES: (1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection. DESIGN: Prospective cohort study using an international online database. SETTING: Multiple hospitals in LMICs worldwide. PATIENTS/PARTICIPANTS: A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013. INTERVENTION: Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury. MAIN OUTCOME MEASUREMENTS: Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel. RESULTS: The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 1: 5.1%, type II: 12.6%, type IIIa: 12.5%, type IIIb: 29.1%, and type IIIc: 16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics. CONCLUSIONS: Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.