Journal of Clinical and Diagnostic Research. 2011 December, Vol-5(8): 1614-1617 1614 1614 Surgical Implant Generation Network (SIGN) Solid Intramedullary Interlocking Nail in the Lower Extremity: An Observational Study from Western Nepal Key Words: SIGN , tibia, femoral, Nepal ABSTRACT Background: Intra-medullary nail ﬁxation has become the standard of treatment for both femoral and tibial shaft fractures. It functions as internal splints that allow secondary fracture healing. The axial and rotational stability of the conventional hollow interlocking nails depends primarily on the locking screws. Surgical Implant Generation Network (SIGN) was formed in 1999, with the vision of creating an equality of fracture care throughout the world. This system has been utilized at a variety of facilities in low income countries throughout the world. Objective: To evaluate the efﬁcacy of SIGN nailing in the long bones of the lower extremity. Method and Materials: This was a hospital based, retrospective study which was conducted in the Orthopaedics Department of the Manipal College of Medical Sciences, Pokhara, Nepal between May, 2010 and August, 2011. A total of 24 cases with fractures of the femur and the tibia were studied. Both closed and open types of fractures were included and the fracture ﬁxation was done by using SIGN interlocking solid nails and instrumentation. The analysis was done by using descriptive statistics and the testing of the hypothesis. The data was analyzed by using Excel 2003, the Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: Out of the 24 patients, 16 (66.7%) were males and 8 (33.3%) were females. The average age of the patients was 29.58, with a range of 13-60 years. An intra-medullary interlocking SIGN nail was performed in 18 (75%) tibial and 6 (25 %) femoral fractures, with 41.7 % being right sided and 58.3% being left sided. The types of fractures which were included were closed= 66.67 % and open fractures= 33.33%. According to the Gustilo-Anderson classiﬁcation, 4.17 % were Gustilo I, 25 % were Gustilo II and 4.17 % were Gustilo III a. Open reduction was done in 58.3 % and closed reduction was done in 41.7 % of the cases. Reaming was done in all the cases and no post-operative infections were noted. There was a signiﬁcant relationship between the type of fracture and factors like the affected side, the method of the fracture reduction and the location of the fracture. Conclusion: The SIGN solid intramedullary interlocking nail shows promising results in comparison to the hollow nail because of its better strength, better accuracy in distal locking and surprisingly better results in infection and non-union MANOJ KUMAR CHAKRABORTY, PABIN THAPA, BRIJESH SATHIAN Orthopaedic Section INTRODUCTION Fractures which involve the shaft of the long bones are common worldwide. The methods which are used to achieve skeletal stabil- ization could vary considerably. These long-bone fractures in the femur and the tibia may be treated with external splints: Plaster of Paris, Fiber cast, external ﬁxation (ﬁxator), and skin traction or internal splints: Rush nails, Kuntschner nails, plates, and screws, in addition to interlocking nails [1].The intra-medullary nail or rod is commonly used for long-bone fracture ﬁxation and it has become the standard treatment for most of the long-bone diaphyseal and selected metaphyseal fractures. Intramedullary nails function as internal splints that allow secondary fracture healing [2]. The axial and rotational stability of the conventional hollow interlocking nails depends primarily on the locking screws [3]. Surgical Implant Generation Network (SIGN) was formed in 1999, with a vision of creating an equality of fracture care throughout the world. While this system has been utilized at a variety of facilities in low income countries throughout the world, the SIGN techniques and implants have also been used in the settings of disaster relief [4,5]. The SIGN solid, stainless steel nail was designed for use in the tibia and it is strong enough for slots rather than holes, to accommodate the interlocking screw. The nail is straight but the proximal and distal ends of the nail have a 9 and 1.5 degree apex posterior bend, respectively. The nail is also used for femoral intra-medullary (IM) nailing and these 2 bends create an effective radius of curvature which closely approximates that of the normal human femur. There are 4 iterations of the interlocking screw which broke in less than 0.5% of the SIGN interlocking nail surgeries [6].Therefore, our objective was to evaluate the efﬁcacy of SIGN interlocking nailing in the long bones of the lower extremity. MATERIALS AND METHODS This was a hospital based, retrospective study which was conducted in the Orthopaedics Department of the Manipal College of Medical Sciences, Pokhara, Nepal, between May, 2010 and August, 2011. A total of 24 cases with shaft fractures of the femur and the tibia were studied. Patients with closed and open fractures were included. The fracture ﬁxation was performed by using SIGN interlocking nails and instrumentation, which was donated by the SIGN organization of RICHLAND, WA, USA for poor people. Original Article