{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:09:06Z","timestamp":1792069746160,"version":"4.4.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T00:00:00Z","timestamp":1670371200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T00:00:00Z","timestamp":1670371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>One of the challenge to manage long bone fracture is the risk of infection. Intramedullary nailing is the standard treatment of long bone shaft fractures. Infection from the surgical site during orthopedic management is posing postoperative burdens in different perspectives like patient perspectives and healthcare facilities. However, there is limited information on the magnitude of infection in Ethiopia after surgical implant generation network (SIGN) nailing in the treatment of long bone shaft fractures. Therefore, the current study aimed to assess the prevalence of infection in patients with long bone shaft fractures treated with surgical implant generation network (SIGN) nailing.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To assess prevalence of infection in patients with long bone shaft fractures treated with SIGN nailing at Felege Hiwot Referral Hospital from January 1, 2015, to December 31, 2018, Bahir Dar, Northwest, Ethiopia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a retrospective study over a period of 4\u00a0years. SIGN surgical-related data, presence or absence of infection from the documented information were collected from the chart\/the source. The types of infection were also collected with the standard classification as superficial, deep and deep with osteomyelitis. Age, sex, fracture pattern, nature of fracture, mechanism of injury, prophylaxis antibiotics, nail type, follow-up in weeks and other factors were also extracted from the patients\u2019 charts with structured checklist. Data were analyzed with statistical package for social sciences (SPSS) version 23. The analyzed data were presented with texts, tables and a graph.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Three hundred and eighty-two long bone fractures were treated by locked SIGN intramedullary nailing during the study period. After screening the inclusion criteria, a total of 311 cases were included in this study. A total of 13 (4.2%) patients who treated with SIGN intramedullary nailing developed infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We conclude that the overall prevalence of infection with SIGN intramedullary nailing is almost similar with the surgeries done in the developed countries.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00590-022-03454-1","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T13:04:20Z","timestamp":1670418260000},"page":"677-684","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Infection after surgical implant generation network (SIGN) nailing in treatment of long bone shaft fractures in Ethiopia: analysis of a 4-year results"],"prefix":"10.1007","volume":"33","author":[{"given":"Birhanu","family":"Beza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almaw","family":"Bitew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debas Yaregal","family":"Melesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,7]]},"reference":[{"key":"3454_CR1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","volume":"21","author":"JL Marsh","year":"2007","unstructured":"Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W et al (2007) Fracture and dislocation classification compendium\u20142007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1-133","journal-title":"J Orthop Trauma"},{"key":"3454_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s0090-022-03329-5","author":"MH Gani","year":"2022","unstructured":"Gani MH, Liang K, Muzafar K, Dev B, Bhat KA et al (2022) Outcomes after primary intramedullary nail fixation of open tibial, femoral fractures in low resource settings. Eur J Orthop Surg Traumatol. https:\/\/doi.org\/10.1007\/s0090-022-03329-5","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"3454_CR3","first-page":"e2020018","volume":"91","author":"A Pedrazzini","year":"2020","unstructured":"Pedrazzini A, Garzia A, Bertoni N, Yewo Simo H, Bisaschi R et al (2020) High energy trauma with complex fracture of the right tibial plateau, compartment syndrome and infection in a professional freestyler motorcyclist. Acta Biomed 91:e2020018","journal-title":"Acta Biomed"},{"key":"3454_CR4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.4103\/1117-6806.188983","volume":"22","author":"OM Babalola","year":"2016","unstructured":"Babalola OM, Ibraheem GH, Ahmed BA, Olawepo A, Agaja SB et al (2016) Open intramedullary nailing for segmental long bone fractures: an effective alternative in a resource restricted environment. Nigerian J Surg 22:90\u201395","journal-title":"Nigerian J Surg"},{"key":"3454_CR5","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/j.injury.2018.07.024","volume":"49","author":"PR Oliveira","year":"2018","unstructured":"Oliveira PR, Leonhardt MC, Carvalho VC, Kojima KE, Silva JS et al (2018) Incidence and risk factors associated with infection after intramedullary nailing of femoral and tibial diaphyseal fractures: Prospective study. Injury 49:1905\u20131911","journal-title":"Injury"},{"key":"3454_CR6","first-page":"87","volume":"16","author":"E Ahmed","year":"2011","unstructured":"Ahmed E (2011) Outcome of SIGN nail initiative in treatment of long bone fractures in Addis Ababa, Ethiopia. East Cent Afr J Surg 16:87\u201396","journal-title":"East Cent Afr J Surg"},{"key":"3454_CR7","doi-asserted-by":"publisher","first-page":"e072","DOI":"10.1097\/OI9.0000000000000072","volume":"3","author":"Y Atwan","year":"2020","unstructured":"Atwan Y, Schemitsch EH (2020) The top three unanswered questions in the management of open fractures. OTA Int 3:e072","journal-title":"OTA Int"},{"key":"3454_CR8","doi-asserted-by":"publisher","first-page":"e198","DOI":"10.1097\/BOT.0000000000000033","volume":"28","author":"W Obremskey","year":"2014","unstructured":"Obremskey W, Molina C, Collinge C, Nana A, Tornetta P 3rd et al (2014) Current practice in the management of open fractures among orthopaedic trauma surgeons. Part A: initial management. A survey of orthopaedic trauma surgeons. J Orthop Trauma 28:e198-202","journal-title":"J Orthop Trauma"},{"key":"3454_CR9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s00068-014-0485-5","volume":"41","author":"A Hofmann","year":"2015","unstructured":"Hofmann A, Dietz SO, Pairon P, Rommens PM (2015) The role of intramedullary nailing in treatment of open fractures. Eur J Trauma Emerg Surg 41:39\u201347","journal-title":"Eur J Trauma Emerg Surg"},{"key":"3454_CR10","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1302\/0301-620X.97B6.34962","volume":"97","author":"P Bennett","year":"2015","unstructured":"Bennett P, Sargeant I, Myatt R, Penn-Barwell J (2015) The management and outcome of open fractures of the femur sustained on the battlefield over a ten-year period. Bone Joint J 97:842\u2013846","journal-title":"Bone Joint J"},{"key":"3454_CR11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/BF00579277","volume":"7","author":"P Garbuio","year":"1997","unstructured":"Garbuio P, G\u00e9rard F, Ridoux PE, Tropet Y, Vichard P (1997) Intramedullary nailing of open and closed tibial shaft fractures. Eur J Orthop Surg Traumatol 7:153\u2013157","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"3454_CR12","first-page":"203","volume":"23","author":"I Khan","year":"2013","unstructured":"Khan I, Javed S, Khan GN, Aziz A (2013) Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture. J Coll Phys Surg Pak 23:203\u2013207","journal-title":"J Coll Phys Surg Pak"},{"key":"3454_CR13","first-page":"48","volume":"11","author":"A Olasinde","year":"2012","unstructured":"Olasinde A, Ogunlusi J, Ikem I (2012) Outcomes of the treatment of gunshot fractures of lower extremities with interlocking nails. SA Orthop J 11:48\u201351","journal-title":"SA Orthop J"},{"key":"3454_CR14","doi-asserted-by":"publisher","first-page":"3270","DOI":"10.1007\/s11999-012-2376-6","volume":"470","author":"PH Kim","year":"2012","unstructured":"Kim PH, Leopold SS (2012) In brief: Gustilo-Anderson classification. [corrected]. Clin Orthop Relat Res 470:3270\u20133274","journal-title":"Clin Orthop Relat Res"},{"key":"3454_CR15","doi-asserted-by":"publisher","first-page":"219","DOI":"10.2174\/1874325001307010219","volume":"7","author":"KG Makridis","year":"2013","unstructured":"Makridis KG, Tosounidis T, Giannoudis PV (2013) Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes. Open Orthop J 7:219\u2013226","journal-title":"Open Orthop J"},{"key":"3454_CR16","first-page":"S160","volume-title":"Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes","author":"K Makridis","year":"2018","unstructured":"Makridis K, Zourntou S, Giannoudis P (2018) Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes. Springer, London, pp S160\u2013S161"},{"key":"3454_CR17","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s00590-012-1016-x","volume":"23","author":"M Seyhan","year":"2013","unstructured":"Seyhan M, Unay K, Sener N (2013) Intramedullary nailing versus percutaneous locked plating of distal extra-articular tibial fractures: a retrospective study. Eur J Orthop Surg Traumatol 23:595\u2013601","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"3454_CR18","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s00264-006-0219-3","volume":"31","author":"IC Ikem","year":"2007","unstructured":"Ikem IC, Ogunlusi JD, Ine HR (2007) Achieving interlocking nails without using an image intensifier. Int Orthop 31:487\u2013490","journal-title":"Int Orthop"},{"key":"3454_CR19","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.1007\/s00264-012-1625-3","volume":"36","author":"J Phillips","year":"2012","unstructured":"Phillips J, Zirkle LG, Gosselin RA (2012) Achieving locked intramedullary fixation of long bone fractures: technology for the developing world. Int Orthop 36:2007\u20132013","journal-title":"Int Orthop"},{"key":"3454_CR20","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3109\/17453674.2011.636680","volume":"82","author":"S Young","year":"2011","unstructured":"Young S, Lie SA, Hallan G, Zirkle LG, Enges\u00e6ter LB et al (2011) Low infection rates after 34,361 intramedullary nail operations in 55 low-and middle-income countries: validation of the Surgical Implant Generation Network (SIGN) online surgical database. Acta Orthop 82:737\u2013743","journal-title":"Acta Orthop"},{"key":"3454_CR21","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3109\/17453674.2011.636680","volume":"82","author":"S Young","year":"2011","unstructured":"Young S, Lie SA, Hallan G, Zirkle LG, Engesaeter LB et al (2011) Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries: validation of the Surgical Implant Generation Network (SIGN) online surgical database. Acta Orthop 82:737\u2013743","journal-title":"Acta Orthop"},{"key":"3454_CR22","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.injury.2016.09.019","volume":"49","author":"W Metsemakers","year":"2018","unstructured":"Metsemakers W, Kuehl R, Moriarty T, Richards R, Verhofstad M et al (2018) Infection after fracture fixation: current surgical and microbiological concepts. Injury 49:511\u2013522","journal-title":"Injury"},{"key":"3454_CR23","first-page":"230949901769271","volume":"25","author":"C Fang","year":"2017","unstructured":"Fang C, Wong T-M, Lau T-W, To KK, Wong SS et al (2017) Infection after fracture osteosynthesis\u2014part I: pathogenesis, diagnosis and classification. J Orthop Surg 25:2309499017692712","journal-title":"J Orthop Surg"},{"key":"3454_CR24","first-page":"230949901769271","volume":"25","author":"C Fang","year":"2017","unstructured":"Fang C, Wong T-M, To KK, Wong SS, Lau T-W et al (2017) Infection after fracture osteosynthesis\u2014part II: treatment. J Orthop Surg 25:2309499017692714","journal-title":"J Orthop Surg"},{"key":"3454_CR25","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1302\/2058-5241.4.180093","volume":"4","author":"S Steinmetz","year":"2019","unstructured":"Steinmetz S, Wernly D, Moerenhout K, Trampuz A, Borens O (2019) Infection after fracture fixation. EFORT Open Rev 4:468\u2013475","journal-title":"EFORT Open Rev"},{"key":"3454_CR26","doi-asserted-by":"publisher","first-page":"S67","DOI":"10.1016\/j.otsr.2016.06.019","volume":"103","author":"P Bonnevialle","year":"2017","unstructured":"Bonnevialle P (2017) Operative treatment of early infection after internal fixation of limb fractures (exclusive of severe open fractures). Orthop Traumatol Surg Res 103:S67\u2013S73","journal-title":"Orthop Traumatol Surg Res"},{"key":"3454_CR27","first-page":"50","volume":"29","author":"MQ Shah","year":"2017","unstructured":"Shah MQ, Zardad MS, Khan A, Ahmed S, Awan AS et al (2017) Surgical site infection in orthopaedic implants and its common bacteria with their sensitivities to antibiotics, in open reduction internal fixation. J Ayub Med Coll Abbottabad 29:50\u201353","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"3454_CR28","first-page":"50","volume":"29","author":"MQ Shah","year":"2017","unstructured":"Shah MQ, Zardad MS, Khan A, Ahmed S, Awan AS et al (2017) Surgical site infection in orthopedic implants and its common bacteria with their sensitivities to antibiotics, in open reduction internal fixation. J Ayub Med Coll Abbottabad 29:50\u201353","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"3454_CR29","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.2106\/JBJS.K.00582","volume":"94","author":"L Jacoby","year":"2012","unstructured":"Jacoby L (2012) Does timing to operative debridement affect infectious complications in open long-bone fractures? J Bone Joint Surg Am 94:1057\u20131064","journal-title":"J Bone Joint Surg Am"},{"key":"3454_CR30","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.4103\/njcp.njcp_294_16","volume":"20","author":"O Salawu","year":"2017","unstructured":"Salawu O, Ibraheem G, Babalola O, Kadir D, Ahmed B et al (2017) Clinical outcomes after open locked intramedullary nailing of closed femoral shaft fractures for adult patients in a Nigerian Hospital. Niger J Clin Pract 20:1316\u20131321","journal-title":"Niger J Clin Pract"},{"key":"3454_CR31","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1007\/s00590-017-1962-4","volume":"27","author":"V Chadayammuri","year":"2017","unstructured":"Chadayammuri V, Herbert B, Hao J, Mavrogenis A, Quispe JC et al (2017) Factors associated with adverse postoperative outcomes in patients with long bone post-traumatic osteomyelitis. Eur J Orthop Surg Traumatol 27:877\u2013882","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"3454_CR32","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.3390\/diagnostics12051289","volume":"12","author":"V Lu","year":"2022","unstructured":"Lu V, Zhang J, Patel R, Zhou AK, Thahir A et al (2022) Fracture related infections and their risk factors for treatment failure\u2014a major trauma centre perspective. Diagnostics 12:1289","journal-title":"Diagnostics"},{"key":"3454_CR33","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s00268-012-1817-4","volume":"37","author":"S Young","year":"2013","unstructured":"Young S, Lie SA, Hallan G, Zirkle LG, Enges\u00e6ter LB et al (2013) Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries. World J Surg 37:349\u2013355","journal-title":"World J Surg"},{"issue":"1","key":"3454_CR34","first-page":"1","volume":"1","author":"S Ibeanusi","year":"2018","unstructured":"Ibeanusi S (2018) Locked intramedullary nailing of fractures. experience from a trauma centre in nigeria: a prospective observational study. Asian J Orthop Res 1(1):1\u201310","journal-title":"Asian J Orthop Res"},{"key":"3454_CR35","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s00590-021-02956-8","volume":"31","author":"AD Iliadis","year":"2021","unstructured":"Iliadis AD, Shivji F, Debuka E, Trompeter A, Narayan B et al (2021) Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI). Eur J Orthop Surg Traumatol 31:957\u2013966","journal-title":"Eur J Orthop Surg Traumatol"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-022-03454-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-022-03454-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-022-03454-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T03:10:06Z","timestamp":1679627406000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-022-03454-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,7]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["3454"],"URL":"https:\/\/doi.org\/10.1007\/s00590-022-03454-1","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,7]]},"assertion":[{"value":"19 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest in preparing this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was asked and was cleared from the ethical committee of college of medicine and health sciences; Bahir Dar University.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical statement"}}]}}