We educate, operate, and donate.
As a result of trauma, millions are injured each year in the developing world and cannot afford proper or timely care for their severe fractures. The worldwide network of SIGN surgeons, trained in the SIGN technique and equipped with SIGN intramedullary (IM) nails, treat these severely injured patients. By providing surgeons in developing nations with training and instrumentation, SIGN is successfully building local orthopaedic surgical capability and improving the quality of fracture care for the injured poor. It is SIGN’s vision that through this network of surgeons, all people would have the opportunity to receive modern surgical treatment and avoid future disability.
Educate: The Premise of SIGN
Education and instrumentation go hand in hand in order to build reliable orthopaedic capability. Even before the birth of SIGN, founder and president Lewis G. Zirkle, MD trained surgeons abroad in effective surgical technique, upholding education as a core value of his work. The SIGN technique is taught to surgeons abroad by an orthopaedic volunteer or a previously trained local surgeon.
The SIGN approach to education includes hands-on training. Surgeons learning the SIGN technique are encouraged by their trainers to practice the technique by participating in surgery and then performing it on their own. When training is complete, ongoing education in trauma and orthopaedic care is achieved through regional and international orthopaedic conferences, follow-up visits from volunteers, and by use of the SIGN surgical database.
Operate: Surgeons Worldwide Create Equality of Fracture Care
Operating in developing countries is an experience unlike that in the United States. The fractures that surgeons abroad treat are generally of a high level of complexity, not only because they are severe (90% of the world’s trauma occurs in the developing world) but also because they have undergone partial healing due to delayed treatment. These severe fractures require surgery for proper healing, and without it the patient faces almost certain disability. Surgeons trained in the SIGN technique take on these difficult procedures, even while lacking live imaging and reliable electricity, revealing their desire to serve the injured poor.
Donate: Because Implants Must Be Given With Training
Upon a follow-up visit to an Indonesian orthopaedic ward in the 1990s, Dr. Zirkle witnessed a patient lying in traction from a femur fracture. This man lay in traction for three years because his fracture had not healed. Although surgeons in this hospital had the knowledge and skill to treat the fracture, the patient could not afford the implant so surgery could not take place. It was in that moment he realized that teaching fracture care must be accompanied by an ongoing supply of implants appropriate for use in local conditions. SIGN implants and equipment are designed and manufactured at SIGN headquarters in Richland, Washington. The SIGN nail is FDA cleared for use in United States, which gives an assurance of the quality of our design, materials and manufacturing.
Sustainability: SIGN Commits to Provide Ongoing Support
SIGN has expanded to 200 hospitals in 41 countries. Though the countries are diverse, they all have a common thread—they all want to provide modern surgical care for their patients. SIGN programs are sustained by a continuous supply of SIGN IM nails, training and communications with volunteer surgeons, and ongoing support from SIGN headquarters and surgeons. SIGN does not commit to a program unless it can be sustained by adequate financial and volunteer resources. All surgeries are reported on the SIGN surgical database to monitor the effectiveness of the SIGN nail. The database has evolved into a forum for surgeons abroad to report suggestions for alternative indications of the SIGN nail, discussing results with other surgeons, and is used as a guide for scheduling shipments of new implants.
SIGN’s plans for the future include expanding the number surgeons trained to use the SIGN IM nail system and designing new implants to repair a broader range of fractures. In the first three quarters of 2009, 14 new programs were started. SIGN recently received FDA approval for its SIGN Hip Construct, designed to repair hip fractures without the use of a C-arm. In these ways, SIGN is keeping its commitment to creating equality of fracture care throughout the world.
