Surgical Implant Generation Network (SIGN) Fin nail versus SIGN standard intramedullary nail for distal diaphyseal femur fractures treated via retrograde approach

Max Bolun Liu; Syed Haider Ali; Billy Thomson Haonga; Edmund Ndalama Eliezer; Patrick David Albright; Saam Morshed; David Shearer

doi:10.1016/j.injury.2019.09.009

Surgical Implant Generation Network (SIGN) Fin nail versus SIGN standard intramedullary nail for distal diaphyseal femur fractures treated via retrograde approach

Injury. 2019 Oct;50(10):1725-1730. doi: 10.1016/j.injury.2019.09.009. Epub 2019 Sep 9.

Authors

Max Bolun Liu¹, Syed Haider Ali², Billy Thomson Haonga³, Edmund Ndalama Eliezer⁴, Patrick David Albright⁵, Saam Morshed⁶, David Shearer⁷

Affiliations

¹ Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. Electronic address: maxliu@stanford.edu.
² Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. Electronic address: syed.ali.research@outlook.com.
³ Department of Orthopaedics, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. Electronic address: bhaonga@gmail.com.
⁴ Department of Orthopaedics, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. Electronic address: ndalama@yahoo.com.
⁵ Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. Electronic address: patrick.albright@ucsf.edu.
⁶ Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. Electronic address: saam.morshed@ucsf.edu.
⁷ Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. Electronic address: david.shearer@ucsf.edu.

PMID: 31540799
DOI: 10.1016/j.injury.2019.09.009

Abstract

Introduction: Surgical fixation of distal diaphyseal femur fractures remains a major challenge in developing countries given limited availability of fluoroscopy. The Surgical Implant Generation Network (SIGN) Standard Intramedullary Nail and SIGN Fin Nail are two modalities developed to address this challenge; the Fin Nail additionally avoids needing to place proximal interlocking screws. While efficacy of the Standard Nail has been established, outcomes following fixation with the Fin Nail are unknown. In this study, we compare outcomes of distal diaphyseal femur fractures treated with each implant.

Methods: A prospective cohort study was conducted from 2012 to 2013 at a single tertiary-referral center in Tanzania. Skeletally mature patients with distal diaphyseal femur fractures treated with either retrograde SIGN Standard Nail or Fin Nail were included. Patients followed-up at 6, 12, 26, and 52 weeks post-operatively. The primary outcome was all-cause reoperation. Secondary outcomes included infection, non-union, malalignment, quality of life (EQ-5D score), pain (VAS score), radiographic healing (RUST score), and function (pain with weight bearing, knee range of motion, and Squat and Smile score).

Results: 74 (85%) of 85 enrolled patients completed the minimum 1-year follow-up. There was no difference in rate of reoperation (p = 1.00), infection (p = 1.00), limb length discrepancy (p = 0.47), non-union (p = 1.00), or coronal or sagittal malalignment (p = 1.00, p = 0.55 respectively) at 1 year. There was furthermore no difference in mean EQ-5D (p = 0.82), VAS pain score (p = 0.43), RUST score (p = 0.44), maximum knee flexion (p = 0.52) and extension (p = 1.00), or Squat and Smile function (p = 1.00) between cohorts at 1 year.

Discussion: Outcomes associated with the SIGN Fin Nail are comparable to those associated with the SIGN Standard Intramedullary Nail at 1 year. The SIGN Fin Nail may be useful as an alternative to Standard locked IM nails for fixation of distal diaphyseal femur fractures.

Keywords: Femur fracture; Fin nail; Intramedullary nail; Retrograde; Tanzania; Trauma.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Bone Nails
Diaphyses
Female
Femoral Fractures / epidemiology
Femoral Fractures / physiopathology
Femoral Fractures / surgery*
Fracture Fixation, Intramedullary / methods*
Fracture Healing / physiology*
Humans
Male
Middle Aged
Prospective Studies
Reoperation / statistics & numerical data*
Surgical Wound Infection / epidemiology
Surgical Wound Infection / surgery*
Tanzania / epidemiology
Treatment Outcome
Weight-Bearing
Young Adult