Date of Award

January 2022

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Adrienne Socci

Second Advisor

Akimu C. Mageza




Musculoskeletal trauma accounts for ever-increasing morbidity and mortality in low- and middle-income countries (LMIC). Different global health models are being pursued to mitigate this trauma burden. SIGN Fracture Care International is a non-profit organization that produces and distributes intramedullary nails to LMIC hospitals at no cost for intra-operative fracture fixation in exchange for cases being uploaded to the SIGN Online Surgical Database (SOSD). The SIGN program was introduced in Zimbabwe, a low-income country, in 2013. By 2020, the program had expanded to 9 centers. This study aimed to evaluate the SIGN model by looking at the population characteristics and clinical outcomes of patients who received the SIGN nail in Zimbabwe as well as intranational trends across the SIGN centers.


We conducted a retrospective review of the SOSD for all cases carried out using the SIGN nail in Zimbabwe between 2013 and 2020. We then carried out univariate statistical analysis to examine the population characteristics and identify statistically significant differences within the outcomes.


1764 patients received operative fixation over the period. The majority were young (36.83 ± 15.13) years and male (74%). The average time to surgery was 22± 20.5 days with over 69% of patients getting surgery after more than 10 days. Femur fracture fixation (72%) was the most common procedure with road traffic accidents (RTAs) being the most common cause of fractures (73%). The majority of patients had no follow-up (61%). Of patients with follow-up, 4% reported infection, 2% deformity and 78% with healing X-rays. There were large differences in volume of patients at different centers with no significant trends in outcomes.


The SIGN program’s model allows for safe surgery mitigating the burden of orthopedic trauma in Zimbabwe. There are large intranational differences in metrics, however with statistical significance between SIGN centers which may be improved through more intranational knowledge sharing. Improved follow-up would allow for more insights to be gleaned from the database.


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