Satisfactory postoperative alignment following retrograde SIGN Fin nailing for femoral shaft fractures

Wilson, Nathaniel M.; Shaw, Jordan; Malaba, Mbonisi; Yugusuk, Fasto L.T.; Nyambati, Philemon; Siy, Alexander B.; Galat, Daniel D.; Koech, Kiprono; Nugent, Dylan; Whiting, Paul S.

doi:10.1097/oi9.0000000000000024

Cited by 4 publications

(10 citation statements)

References 19 publications

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“…On immediate postoperative radiographs, the authors found no difference in overall alignment or rates of malalignment >5° between groups. [ 16 ] The current study builds upon this previous work by examining postoperative radiographic alignment at a minimum of 6 months following surgical fixation. The relatively low rate of malalignment >10° in any plane (6%) suggests that the SIGN Fin nail is able to successfully maintain satisfactory fracture alignment for a minimum of 6 months, at which time most femoral shaft fractures have healed.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have examined the immediate postoperative alignment achieved by the Fin nail when used in the retrograde treatment of femoral shaft fractures in adults. [ 16 , 17 ] To our knowledge, however, no large study has investigated the long term clinical and radiographic performance of the SIGN Fin nail when used in this fashion. The purpose of this study is to examine long term clinical and radiographic outcomes in a large series of femoral shaft fractures treated with the SIGN Fin nail (Figs.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures

Wilson

Moen²,

Shaw

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Purpose: The Surgical Implant Generation Network (SIGN) intramedullary nail was designed for use in resource limited settings which often lack fluoroscopy, specialized fracture tables, and power reaming. A newer design iteration, the SIGN Fin nail, was developed to further simplify retrograde femoral nailing by making proximal interlocking screw placement unnecessary. Instead, the leading end of the Fin nail achieves stability through an interference fit within the proximal femoral canal. While the performance of the traditional SIGN nail has been reported previously, no large series has examined long-term clinical and radiographic outcomes of femoral shaft fractures treated with the SIGN Fin nail. Methods: The SIGN online surgical database was used to identify all adult femoral shaft fractures treated with the SIGN Fin nail since its introduction. All patients with minimum 6 month clinical and radiographic follow-up were included in the analysis. Available demographic, injury, and surgical characteristics were recorded. Fracture alignment was evaluated on final follow-up radiographs using a previously validated on-screen protractor tool. Coronal and sagittal plane alignment measurements were recorded as deviation from anatomic alignment (DFAA), with units in degrees. Fracture healing was assessed on final follow-up radiographs, with union defined as any bridging callus and/or cortical remodeling across one cortex on orthogonal views. Clinical outcomes available in the database included knee range of motion (ROM) greater than 90° and weight-bearing status at final follow-up. Clinical and radiographic outcomes were then compared between patients with united and nonunited fractures. Results: The database query identified 249 femoral shaft fractures stabilized with the Fin nail in 242 patients who had minimum 6 month clinical and radiographic follow-up. Final follow-up radiographs were performed at an average of 48 weeks postoperatively. Average coronal and sagittal plane alignment measured on final follow-up radiographs were 2.18° and 2.58°, respectively. The rate of malalignment (DFAA > 10° in either plane) at final follow-up was 6%. Two hundred twenty-nine fractures (92%) were united at final follow-up. Overall, 209 (84%) of patients achieved full weight bearing and 214 (86%) achieved knee ROM >90° at final follow-up. Compared to patients with united fractures, those with nonunion were less likely to achieve full weight bearing (20% vs 90%, P < .001) and knee ROM >90° (30% vs 91%, P < .001). There was no significant difference in mean DFAA between united and nonunited fractures in the coronal (2.1° vs 3.8°, P = .298) or sagittal (2.5° vs 3.5°, P = .528) planes. Conclusion: The SIGN Fin nail achieves satisfactory radiographic alignment and clinical outcomes at minimum 6 month follow-up...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures

Wilson

Moen²,

Shaw

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…Fracture alignment was measuring using degrees of DFAA, and measurements were made utilizing an on screen protractor tool (Screen Protractor; Iconico Inc, New York, New York) as previously described. [7,8] which was layered over films from the database (Fig. 2).…”

Section: Fracture Alignment Measurements and Classificationmentioning

confidence: 99%

Radiographic outcomes of femur fractures following SIGN Fin nailing in low- and middle-income countries

Birner¹,

Hetzel²,

Wilson³

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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To measure the effectiveness of the Surgical Implant Generation Network (SIGN) Fin nail for achieving satisfactory postoperative radiographic alignment following femoral shaft fractures.Methods: Femoral shaft fractures stabilized with the SIGN Fin nail were identified using the SIGN Online Surgical Database. A random number generator was used to identify 500 femur fractures fixed within 6 weeks of injury for which postoperative radiographs were available. Fractures were classified using OTA/AO and Winquist-Hansen classification systems. Deviation from anatomic alignment was measured on anterior-posterior and lateral radiographs using an on-screen protractor tool. Other clinical variables recorded in the SIGN Online Surgical Database were also analyzed. Simple logistic regression was used to assess for associations between subject and surgical characteristics and misalignment status. Intra-and inter-rater agreement was assessed with intraclass correlation coefficient (ICC).Results: The overall rate of malalignment >5°was 9.4%. Factors associated with increased incidence of malalignment include older age, increased time to surgery, distal diaphyseal location, closed (vs open) reduction, degree of comminution, and fracture classification. Intra-rater ICC was 0.70 (0.52, 0.82) in the coronal plane and 0.55 (0.32, 0.72) in the sagittal plane. Inter-rater ICC was 0.37 (0.08, 0.60) and 0.32 (0.05, 0.54), respectively. Conclusion:The SIGN Fin nail is an effective implant for fixation of femoral shaft fractures in resource-limited regions, achieving rates of satisfactory postoperative alignment comparable to that of the standard SIGN nail as well as femoral shaft fractures treated in North American Trauma Centers. Further research is required to investigate rotational alignment and long-term clinical outcomes for the SIGN Fin nail.Level of evidence: IV.

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“…Although there is a growing body of evidence supporting the use of the SIGN FIN nail for femoral fractures, there is no evidence of the use of SIGN FIN nail for treatment of tibial fractures. 13–15…”

Section: Introductionmentioning

confidence: 99%

“…10 Although there is a growing body of evidence supporting the use of the SIGN FIN nail for femoral fractures, there is no evidence of the use of SIGN FIN nail for treatment of tibial fractures. [13][14][15] In this study, we report outcomes with SIGN FIN nailing of tibial fractures to compare with those performed with the standard SIGN tibial nail or other locked intramedullary nails and to determine whether there are increased complications in the SIGN FIN group. We used the SIGN FIN nail because of a shortage of standard locked nails in our setup.…”

Section: Introductionmentioning

confidence: 99%

Outcome of tibial shaft fractures treated with the SIGN FIN nail at Addis Ababa Emergency, Burn, and Trauma Hospital (AaEBT) Addis Ababa, Ethiopia

Tesso

Zirkle²,

Worku

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives:To determine the outcome of tibial fractures treated with the SIGN FIN nail.Study Design:Retrospective case series study.Study Setting:Trauma center.Methods and Materials:We included 14 patients aged 18–51 years with 16 tibial fractures in this study. Patients were followed clinically and radiographically, and the minimum time followed was 6 months. Johner and Wruhs criteria with modification were used to assess the outcome.Result:There were 11 male (78.6%) and three female (21.4%) patients. The mean age was 32.44 ± 8.98 (range 18–51) years. The right-sided tibia was injured in six as compared with the left side in four, and four patients had bilateral injuries. Eight (50%) fractures were closed fractures, whereas the rest eight (50%) were open types of fractures. Among the latter, half (n = 4; 50%) fractures were Gustilo type II fractures, while three (37.5%) fractures were Gustilo type III fractures, and one (12.5%) patient had a Gustilo type I fracture. All patients had radiologic union. There were no infections or secondary surgery for any reason. Excellent, good, and fair results were achieved in 62.5%, 25%, and 12.5%, respectively. All patients were able to return to their preinjury activity except two patients.Conclusion:SIGN FIN nail is an option for treating tibial shaft fractures with good outcomes and few complications in selected fractures.Level of evidence:Level IV

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Satisfactory postoperative alignment following retrograde SIGN Fin nailing for femoral shaft fractures

Cited by 4 publications

References 19 publications

Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures

Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures

Radiographic outcomes of femur fractures following SIGN Fin nailing in low- and middle-income countries

Outcome of tibial shaft fractures treated with the SIGN FIN nail at Addis Ababa Emergency, Burn, and Trauma Hospital (AaEBT) Addis Ababa, Ethiopia

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