Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Aug;48(8):2179-2187.
doi: 10.1007/s00264-024-06192-7. Epub 2024 May 18.

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

Juan Carlos Perdomo-Lizarraga  1   2 , Dennys J Andrade-Arellano  3   4 , Marco Necchi  3   5 , Marcello Zavatta  6 , Marcella Ryan-Coker  3   7   8 , Richmond Dixon-Cole  3 , Ernesto Muñoz-Mahamud  9   10   11 , Andrés Combalia  12   13   14
Affiliations
Comparative Study

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

Juan Carlos Perdomo-Lizarraga et al. Int Orthop. 2024 Aug.

Abstract

Purpose: Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach.

Material and methods: This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated.

Results: A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57).

Conclusions: Both options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

Keywords: Developing countries; Femoral fractures; Intramedullary fracture fixation; Orthopedic surgery.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
40 year old male patient with femoral midshaft fractures treated using SSN®, (a, b) preoperative radiographs, (c, d) postoperative radiographs, (e, f) consolidation at the follow up at 12 months
Fig. 2
Fig. 2
Characteristics of SIGN® Standard Nail and SIGN® Fin Nail
Fig. 3
Fig. 3
A 38 year old male patient with femoral midshaft fractures treated using SSN®, (a, b) preoperative radiographs, (c, d) postoperative radiographs, (e, f) consolidation at the follow up at 12 months
Fig. 4
Fig. 4
A 18 year old male patient with distal shaft fractures treated using SFN®, (a, b) preoperative radiographs, (c, d) postoperative radiographs, (e, f) consolidation at the follow up at 12 months
Fig. 5
Fig. 5
A 40 year old female patient with femoral midshaft fractures treated using SFN®, (a, b) preoperative radiographs, (c, d) postoperative radiographs, (e, f) consolidation at the follow up at 12 months
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kramer EJ, Shearer D, Morshed S. The use of traction for treating femoral shaft fractures in low- and middle-income countries: a systematic review. Int Orthop. 2016;40(5):875–883. doi: 10.1007/s00264-015-3081-3. - DOI - PubMed
    1. Nester M, Borrelli J., Jr Distal femur fractures management and evolution in the last century. Int Orthop. 2023;47(8):2125–2135. doi: 10.1007/s00264-023-05782-1. - DOI - PubMed
    1. Rossiter ND. Trauma-the forgotten pandemic? Int Orthop. 2022;46(1):3–11. doi: 10.1007/s00264-021-05213-z. - DOI - PMC - PubMed
    1. Zafar SN, Canner JK, Nagarajan N, Kushner AL; SOSAS4 Research Group Road traffic injuries: Cross-sectional cluster randomized countrywide population data from 4 low-income countries. Int J Surg. 2018;52:237–242. doi: 10.1016/j.ijsu.2018.02.034. - DOI - PubMed
    1. Salman LA, Al-Ani A, Radi MFA, Abudalou AF, Baroudi OM, Ajaj AA, et al. Open versus closed intramedullary nailing of femur shaft fractures in adults: a systematic review and meta-analysis. Int Orthop. 2023;47(12):3031–3041. doi: 10.1007/s00264-023-05740-x. - DOI - PMC - PubMed

Publication types