TY  - BOOK
AU  - Katembo, Albert 
AU  - Ngayomela,  Isidor. H
TI  -  Outcome of Sign Nail Surgeries in the Treatment of Long Bone Fractures at Bugando Medical Centre in Mwanza, Tanzania
PY  - 2012///
CY  - Mwanza, Tanzania
PB  - Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 
KW  -  
N2  - Abstract: 

Introduction: The Surgical Implant Generation Network (SIGN) intramedullary nailing system was designed to treat long bone fractures in limited resource-countries where image intensifier, power equipment, and fracture tables are often not available. We conducted this study to describe our own experience with Surgical Implant Generation Network (SIGN) nailing in the treatment of long bone fractures in our local setting. 

Methods and Patients: This was a retrospective study conducted at Bugando medical centre in northwestern Tanzania over a period of 6 months from August, 2016 to February, 2012 covering surgeries done from July 2009 through June, 2011 (a period of 2 years). Data was derived from SIGN database at Bugando medical centre and analyzed using SPSS version 17.0.

Results: A total of 276 patients were studied. Their ages ranged from 11 to 90 years with a median age of 35 years. Males outnumbered females by a ratio of 4: 1. Road traffic accident was the most common cause of fractures according for 82.6% of cases. 234 (84.8%) fractures were closed and 42 (15.2%) were open. According to the Gustillo-Anderson classification, open fractures were classified as follows; Gustillo 15.8%, Gustillo II, 9.1% and Gustillo IIIa 0.4%. At presentation 182 (65.9%) fractures were fresh and 94 (34.1%) were old as a result of initial treatment failure. The majority of patients (56.1%) who had open fractures underwent surgical wound debridement between 8-24 hours after injury and most of them (95.2%) received antibiotics before debridement. The majority of fractures (61.2%) were on the right side and the femur was the most frequent bone affected in 65.6% of cases. The fractures were proximal shaft in 19.6% cases, mid shaft in 17.0% cases, distal shaft in 40.6% cases and more than one location in 22.8% of cases, with 92.7% of them being simple (spiral/ oblique/ transverse), 6.9% being segmented and 0.4% being comminuted. The time taken from injury to definitive surgery ranged from 1 day to 143 weeks with a median duration of 2.4 weeks. Retrograde femur was the most common surgical approach performed in 33.7% of fractures. Standard SIGN nails were commonly used in 88.8% of cases and majority of them (88.0%) were locked both proximally and distally. Reaming was done in all the cases. Post-operative reduction and nail position was excellent in all cases. The median duration of post-operative hospital stay was 8 days (range 4-42 days). Majority of patients (92.9%) started partial weight bearing with crutches within the first two weeks. The infection rate was 1.8% and other complications were minimal and acceptable. Fracture healing by X-ray was reported in 95.6% of cases and the median time for radiological healing as defined by X-rays was 5.2 (range 3-12) months. Majority of knees and elbow had at least 90 degree of flexion in 92.0% of cases. Only 106 (38.4%) and 29 (10.5%) patients returned for follow up at 6 weeks and 3 months respectively. 

Conclusion: Surgical Implant Generation Network (SIGN) nailing promotes predictable fracture healing with low infection rate, minimal post-operative complications, short post-operative hospital stay and early mobilization of the patient. This makes SIGN nailing system the best treatment for all long bone fracture fixation in our situation where real-time imaging and fracture tables are not always available though we have persistently been able to sustain with refurbished power reamers/drills from donations.

ER  -