Early clinical cxperience with the SIGN hip construct: a retrospective case series.

Justin Roth,David Shearer,Lewis Zirkle,John Ibrahim,John Schlechter,Brian Goldman

doi:10.1051/sicotj/2018050

Abstract

Background: As the population ages, the developing world industrializes, and more urban centers emerge, the burden of orthopedic trauma will steadily increase. SIGN Fracture Care International has developed a unique intramedullary device for fixation of hip fractures in low-resource settings lacking fluoroscopy. The purpose of this study is to report the safety profile and complication rate for a consecutive series of hip fracture patients managed using this implant.Methods: We conducted a retrospective analysis of the first 170 patients treated with the SIGN Hip Construct (SHC) from 2009 to 2014 using the SIGN Online Surgical Database (SOSD). Patients with follow-up greater than 12 weeks and adequate radiographs were included. Data recorded include patient demographics, time-to-surgery, union rate, AO/OTA classification, complications, neck-shaft angle, and clinical outcomes including painless weight bearing and knee flexion greater than 90°.Results: Of 170 patients, 71 met inclusion criteria with mean follow-up of 39 weeks. Mean age was 49.5 and by WHO, regions were Africa (27), Eastern Mediterranean (21), Western Pacific (17), Americas (3), and Southeast Asia (3). Fractures included intertrochanteric (55), subtrochanteric (7), femoral neck (4), and combined (5). Reduction quality was good in 35 (49%), acceptable in 19 (27%), and poor in 17 (24%). Major complications consisted of varus collapse (6), non- or delayed union (3), intra-articular screw (5), and infection (3). Average postoperative neck-shaft angle was 126° and 119.3° at final follow-up.Conclusions: This is the first comprehensive report of a novel implant for hip fractures specifically designed for low-resource settings. The early clinical data and outcomes suggest that the SHC can be safely inserted in the absence of fluoroscopy, and facilitates early mobilization while maintaining acceptable reduction until union.

Highlights

As the global population grows and ages, the number of hip fractures increases annually
Hip fractures most often result from low-energy falls in older patients or less commonly from high-energy trauma in younger patients [3]
The SIGN Hip Construct (SHC) uses simple hand instruments combined with an open reduction to diminish the need for fluoroscopy [8]

Summary

Introduction

As the global population grows and ages, the number of hip fractures increases annually. Hip fractures totaled 1.6 million in 1990 and are projected to reach 6.26 million by 2050 [1]. Developing countries in Asia, Africa, and Latin America are predicted to experience the largest growth due to the aging population and increasing prevalence of osteoporosis [2]. The SIGN Hip Construct (SHC) was designed to overcome these barriers (Figure 1). The SHC uses simple hand instruments combined with an open reduction to diminish the need for fluoroscopy [8]. Implants are donated at no cost to participating hospitals provided sites provide surgery and follow-up data through an online database [9,10,11,12,13]. At the time of writing, 47 hospitals are using the

Objectives

Methods

Results

Discussion

Conclusion