Faseeh Shahab, Shahabuddin.
Stabilization of Open Femoral Fractures with the SIGN Intramedullary Nail: Treatment Protocol and Early Clinical Results.
J Surg Pak Jan ;20(3):87-91.

Objective: To evaluate the effectiveness of SIGN-Nail (Surgical Implant Generation Network®) for the treatment of open femoral fractures. Study design: Case-Series. Place & Duration of study: Department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from September 2010 to June 2012. Methodology: Patients with open fractures of femur were included in the study. Femoral IM nailing was done using SIGN (Surgical Implant Generation Network®) nail with standard SIGN-technique with hand reaming without using bone-grafting or image intensifier. Patients were evaluated for infection, radiographic parameters, range of movements, time to weight bearing (partial and complete) and complications or revision surgery, if needed. Results: There were a total of twenty-two (21 male and 1 female) patients in this series. The mechanism of injury was gunshot in 12, bomb blast in 4 and road traffic accident in 6 cases. Seventeen (77%) patients had Gustilo Type IIIa fracture, 3 (14%) patients had Type IIIb fracture and two (9%) patients had Type II fracture. The average time from injury to surgery was 13.8 days (range 2 to 35 days). Two patients developed surgical site infection. The frequency of infection in Type IIIa fractures was 5.8% (1/17) and in Type IIIb fractures 33% (1/3). In follow up all patients had greater than 90 degrees flexion at the knee joint. Twenty patients (91%) were full weight bearing at 4 months. Two revision surgeries were done. Bone grafting plus exchange nailing was done in both the patients to achieve union. Conclusion: Use of SIGN-nail is an effective treatment modality in treating open fractures of femur with excellent fracture healing.

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