Population characteristics, outcomes, and centerwide insights of the Zimbabwe national experience with the SIGN intramedullary nail (2013–2020)

Abstract

Purpose: SIGN Fracture international is a non-profit organization that provides intramedullary nails to SIGN centres at no cost for intra-operative fracture fixation in exchange for cases being uploaded to the SIGN Online Surgical Database (SOSD). The SIGN program was introduced in Zimbabwe in 2013 and had expanded to nine hospitals at the end of 2020. This study aimed to evaluate the population characteristics and clinical outcomes of patients who received the SIGN nail in Zimbabwe as well as intranational trends across SIGN centres. Methods: We conducted a retrospective review of the SOSD for all cases carried out in Zimbabwe between 2013 and 2020. Results: A total of 1764 patients received operative fixation over the period. The majority were young (36.83 ± 15.13) years and male (74%). The average time to surgery was 22 ± 20.5 days with over 69% of patients getting surgery after more than ten days. Femur fracture fixation (72%) was the most common procedure with road traffic accidents (RTAs) being the most common cause of fractures (73%). The majority of patients had no follow-up (61%). Of patients with follow-up, 4% reported infection, 2% deformity, and 78% with healing X-rays. There were large differences in volume of patients at different centres with no significant trends in outcomes. Conclusion: The SIGN program allows for safe surgery in Zimbabwe. There are large intranational differences of no particular trend across SIGN centres which may be improved through more intranational knowledge sharing. Improved follow-up would allow for more insights to be gleaned from the database.