Treatment of Long Bones with a Universal Intramedullary Nail-System in a Developing Country at Hôpital Albert Schweitzer Haiti

Stephen Addington

doi:10.4172/2161-0533.1000156

Abstract

Objective: To evaluate long bone fracture care in a resource-poor hospital by a European midterm volunteer orthopedic surgeon, using a tactile intramedullary nail system without intraoperative image intensifier or fracture table. Methods: The first twenty cases treated by a single orthopedic surgeon using a universal intramedullary nail system (SIGN-nail) were analyzed using six-week to three-month follow-up series. Clinical follow-up occurred two weeks postoperatively with additional clinical and radiological follow-up at six-week and three-month timepoints. Results: All twenty cases were negative for signs of infection, broken interlocking screws, or need for revision at respective three-month timepoints. All patients were at full weight-bearing capacity after six weeks. The SIGN-nail system also provided succesfull management of a complex 3D-correctionosteotomy case. Conclusions: The SIGN-nail system is an effective, tactile system that can be used with satisfactory results without the need for an intraoperative image intensifier or fracture table. Its practical and minimalist nature makes it a favorable solution for long bone fracture care in resource-poor settings. A six-month time period seems to be adequate for midterm volunteer orthopedic-surgeons, as it allows adaptation to new settings and unfamiliar systems.

Highlights

Hôpital Albert Schweitzer (HAS), built in 1956, is a 130-bed, private, nonprofit facility that serves a population of roughly 340,000 in the Artibonite Valley of central Haiti
All twenty cases were negative for signs of infection, broken interlocking screws, or need for revision at respective three-month timepoints
The SIGN-nail system is an effective, tactile system that can be used with satisfactory results without the need for an intraoperative image intensifier or fracture table

Summary

Introduction

Hôpital Albert Schweitzer (HAS), built in 1956, is a 130-bed, private, nonprofit facility that serves a population of roughly 340,000 in the Artibonite Valley of central Haiti. In 2011, a Surgical Project was established by the Bündner Partnerschaft Hôpital Albert Schweitzer Haiti (BPHASH). Following the horrific 2010 earthquake in Haiti, several significant projects for immediate support were started by large BPHASH fundraising activities in Switzerland and Germany, including the financing of the Pediatric Service running costs (Swiss Pediatric Program) and a Social Service Program that covers the cost of care for indigent patients. A universal nail-system (Surgical Implant Generation Network (SIGN)), a non-profit organization from America, is available at HAS for the treatment of long bones (e.g., fractures and pseudarthoses). The SIGN system was designed for solid intramedullary fracture fixation in developing countries where patients could not afford commercial cannulated interlocking nails and where intra-operative imaging and fractures tables are often not available [2]

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Conclusion