{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T04:39:19Z","timestamp":1772771959895,"version":"3.50.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T00:00:00Z","timestamp":1596585600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose:<\/jats:title>\n            <jats:p>The Surgical Implant Generation Network (SIGN) intramedullary nail was designed for use in resource limited settings which often lack fluoroscopy, specialized fracture tables, and power reaming. A newer design iteration, the SIGN Fin nail, was developed to further simplify retrograde femoral nailing by making proximal interlocking screw placement unnecessary. Instead, the leading end of the Fin nail achieves stability through an interference fit within the proximal femoral canal. While the performance of the traditional SIGN nail has been reported previously, no large series has examined long-term clinical and radiographic outcomes of femoral shaft fractures treated with the SIGN Fin nail.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>The SIGN online surgical database was used to identify all adult femoral shaft fractures treated with the SIGN Fin nail since its introduction. All patients with minimum 6 month clinical and radiographic follow-up were included in the analysis. Available demographic, injury, and surgical characteristics were recorded. Fracture alignment was evaluated on final follow-up radiographs using a previously validated on-screen protractor tool. Coronal and sagittal plane alignment measurements were recorded as deviation from anatomic alignment (DFAA), with units in degrees. Fracture healing was assessed on final follow-up radiographs, with union defined as any bridging callus and\/or cortical remodeling across one cortex on orthogonal views. Clinical outcomes available in the database included knee range of motion (ROM) greater than 90\u00b0 and weight-bearing status at final follow-up. Clinical and radiographic outcomes were then compared between patients with united and nonunited fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The database query identified 249 femoral shaft fractures stabilized with the Fin nail in 242 patients who had minimum 6 month clinical and radiographic follow-up. Final follow-up radiographs were performed at an average of 48 weeks postoperatively. Average coronal and sagittal plane alignment measured on final follow-up radiographs were 2.18\u00b0 and 2.58\u00b0, respectively. The rate of malalignment (DFAA &gt; 10\u00b0 in either plane) at final follow-up was 6%. Two hundred twenty-nine fractures (92%) were united at final follow-up. Overall, 209 (84%) of patients achieved full weight bearing and 214 (86%) achieved knee ROM &gt;90\u00b0 at final follow-up. Compared to patients with united fractures, those with nonunion were less likely to achieve full weight bearing (20% vs 90%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.001) and knee ROM &gt;90\u00b0 (30% vs 91%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.001). There was no significant difference in mean DFAA between united and nonunited fractures in the coronal (2.1\u00b0 vs 3.8\u00b0, <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a=\u200a.298) or sagittal (2.5\u00b0 vs 3.5\u00b0, <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a=\u200a.528) planes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>The SIGN Fin nail achieves satisfactory radiographic alignment and clinical outcomes at minimum 6 month follow-up. The overall union rate is comparable to that achieved with the standard SIGN nail. Ease of implantation makes the Fin nail an attractive option in resource-limited settings.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/oi9.0000000000000086","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T17:00:31Z","timestamp":1596646831000},"page":"e086","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures"],"prefix":"10.1097","volume":"3","author":[{"given":"Nathaniel M.","family":"Wilson","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew T.","family":"Moen","sequence":"additional","affiliation":[{"name":"SIGN Fracture Care International, Richland, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan T.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M.","family":"Graf","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Behlmer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha M.","family":"Simske","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lewis G.","family":"Zirkle","sequence":"additional","affiliation":[{"name":"SIGN Fracture Care International, Richland, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul S.","family":"Whiting","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,9]]},"reference":[{"key":"R1-20231103","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"Lancet Lond Engl."},{"key":"R2-20231103","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1007\/s11999-008-0387-0","article-title":"Injuries in developing countries\u2014how can we help? 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