Outcome of surgical implant generation network nail initiative in treatment of long bone shaft fractures in Kenya

Abstract

Background: Closed interlocked intra-medullary nailing (IM), the standard method of treating of long bone shaft fracture, has been a dream to most resource poor hospitals like Kenyan regional hospitals. Surgical implant generation network (SIGN) initiative employs use of external jigs and slot finders instead of expensive fluoroscopy and fracture table to achieve interlocked IM nailing. This study describes the authors experience and analysis of outcome of this initiative. Objective: To describe applicability of the SIGN initiative in fracture care in a Kenyan hospital. Setting: Embu Provincial Hospital, Kenya. Methods: Seventy eight consecutive patients with 20 tibia and 60 femur fractures were done SIGN interlocking nail at Embu Provincial Hospital, Kenya between December 2005 and December 2007. Patient demographic, fracture characteristics and outcome measures of locked nail rate, duration of surgery, hospital stay, complication rate, weight bearing time and union time and rate were prospectively studied. Results: Male to female ratio was 3:1 and the age range was 18 to 82 years. There were 63 closed and 17 open fractures of which 57/80 (71.25%) recent fractures, 12/80 (15%) non-unions, 6/80 (7.5%) mal-unions and 5/80 (6.25%) due to failed plating. There were 18/80 (22.5%) retrograde femur, 42/80 (52.5%) Antegrade femur and 20/80 (25%) tibia cases done. Interlocking was achieved in 76/80 (95%) of the cases. Surgical duration was 60 -180 minutes and hospital stay was one to three weeks post intervention. Complications included superficial infection 4/80 (5%), deep infection 2/80 (2.5%) and screw loosening 4/80 (5%). Time to union averaged 18 1/2 weeks with a union rate of 93%. Conclusion: SIGN initiative a valuable technology in shaft fractures fixation with comparable results and is applicable in the resource poor hospitals.