The use of the SIGN nail in treatment of long bone fractures at by hfIE18

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									The use of the SIGN nail in
  treatment of long bone
   fractures at Kampala
          Uganda




               Dr.Partrick Sekimpi
       Orthopaedic Surgeon Traumatoligist
      Lecturer Department Of Orthopaedics
               Makerere University
 Road Traffic Injury epidemic
• Major cause of morbidity/mortality worldwide

• 1.2m deaths & 50m nonfatal injuries annually

• Top 10 causes of global burden of disease:
                2000                         2020 (projected)
1.   Lower respiratory infections    1.    Ischemic heart disease
2.   HIV/AIDS                        2.    Unipolar major depression
3.   Unipolar depressive disorders   3. Road traffic injuries
4.   Diarrheal diseases              4.    Cerebrovascular disease
5.   Meningitis                      5.    Chronic obstructive pulmonary disease
6.   Ischemic heart disease          6.    Lower respiratory infections
7.   Childhood cluster diseases      7.    Tuberculosis
8.   Cerebrovascular disease         8.    War
9. Road traffic injuries             9.    Diarrheal diseases
10. Malaria                          10.   HIV/AIDS
             Orthopaedic Surgeons per 100,000 people

10
 9
 8
 7
 6
 5
 4
 3
 2
 1
 0
     UK   Romania   Hungary   Australia   USA   Germany   Uganda   Malawi
    Long bone fractures patterns at
           Mulago hospital
•   397 surgical admissions
•   35% fractures of which
•   Femur 35%
•   Tibia 27.5%
•   25.5%open fractures
•   Male to female ratio3:1
•   Productive age group
•   62% caused by RTA
               Management
• Traction
  – skeletal
        Management Evolution
• Traction
  – skeletal




• Operative
  – unlocked IM nail
  – locked IM nail
               SIGN NAIL
• 2100 cases done at Mulago and 47000
  worldwide
• Solid IM nail with a jig for proximal and
  distal locking with no imaging
• Fracture reduced open
• Hand reaming
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
          Sign nail versatility
• Locked/unlocked (Fin)
• Antegrade/retrograde
• Femur/tibia/humerus
• Extremes of shaft
• Open/closed
Positive effect of sign on output
    Out comes of 71 isolated sign
      cases followed for 1year
           prospectively
• Mean age 30.4 (range 15-70),male to female 4:1
• Average time in surgery 74 minutes
• No transfusion was done and i.v cetriaxone ig at
  induction of Anaesthesia was used and continued for
  3days
• 7days post operative stay and 21days pre op
• Follow up clinic 78% at 6weeks
• 3% superficial infection 1.5%deep infection
• Delayed healing 6.6%
• Knee stiffness 2.5%
• DVT rare
                Hospital stay
•   Despite all the hospital stay is still high
•   21sign and 31 for all
•   This affects the bread winner 18-45
•   Reasons =scatter of patients to different
    surgical wards, human resource lack,
    limited theatre time
•
 Efforts to reduce hospital stay
• Collaborations with institutions and
  individual groups
• Commend HVO,SIGN Project with
  Whitney foundation, Steve tower.
• We have piloted a model of treating
  fractures in 24 HRS with UBC team
  Resultng 72 hr hospital stay
            CONCLUSION
• Long bone fractures are an epidemic
• IM nailing is feasible in these settings with
  no imaging facilities through supporting
  efforts like SIGN
• We need broader approach to address the
  epidemic from roads to rehabilitation
• Trauma centers in major cities to
  centralize services

								
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