• Mohammad Naeem-Ur- Razaq
  • Muhammad Qasim
  • Muhammad Ayaz Khan
  • Ahmad Sohail Sahibzada
  • Shahid Sultan


Background: Many hospitals in our country lack surgical expertise and operating room facilitieslike image intensifier and fractures table to carry out closed interlocking nails (ILN) in femoral shaftfractures. But availability of Surgical Implant Generation Network (SIGN) interlocking nails &nailing instrumentation have made open ILN of these fractures possible at very basic level of ourhealth care system. We have carried out open SIGN nailing in patients with closed fractures of shaftfemur without the use of image intensifier. Result for fracture union was evaluated both clinicallyand radio-logically, and graded at 8 months (32 weeks) after treatment by Thoressen’s criteria.Methods: An experimental study of open SIGN nailing was carried out on 47 patients with fracturesshaft of femur who had been admitted to our tertiary care hospital from January 2006 to December2007. Inclusion criteria were adult patients older than 16 years with closed fractures of the shaftfemur, and have presented within a week of the injury, and have not had any previous surgicaltreatment for the fracture. Malnourished patients and patients with open, pathological fractures andnon union cases were excluded from the study. A standard protocol was followed on all patients,which is describing below. The data obtained was analysed using SPSS. Results: The union rate was97.83% in open nailing at 32 weeks after surgery and the Mean±SD time to union was 19.65±5.19weeks (ranges from 16–32 weeks).We obtained excellent results in 39 patients (83.33%), good in 4patients (8.50%), fair in 3 patients (6.38%) and poor in one (2.12%). Conclusions: The open SIGNnailing, without the use of image intensifier, for treatment of closed fractures of shaft femur achievesexcellent result in term of fracture union. Results obtained are comparable to the results of closedinterlocking nailing, requires less expertise and resources, and its use is recommended for long bonesfracture care at the very level of our health care system.Keywords: SIGN nailing, Interlocking nailing, Image intensifier, Closed femoral shaft fracture,image intensifier


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