SIGN FRACTURE CARE INTERNATIONAL
Programs
Affordable Orthopaedic Care Initiative
NEARLY HALF OF THE WORLD LIVES ON LESS THAN $8.30 PER DAY. PATIENTS ARE TOO POOR TO BUY THE IMPLANTS NEEDED, AND MOST HOSPITALS DO NOT HAVE THE RESOURCES TO PURCHASE THE IMPLANTS. WHEN A PERSON LIVING IN A LOW- OR MIDDLE-INCOME COUNTRY (LMIC) BREAKS AN ARM OR LEG AND CANNOT AFFORD APPROPRIATE CARE, IT CAN EASILY SEND THEIR WHOLE FAMILY SPIRALING INTO POVERTY. WE DEVELOPED AN INNOVATIVE IMPLANT SYSTEM FOR TREATING PATIENTS IN LOW-RESOURCE HOSPITALS. THIS SYSTEM CAN BE USED WITHOUT EXPENSIVE X-RAY IMAGING OR ELECTRICITY. SIGN SURGERY TYPICALLY ENABLES A PATIENT WITH A FRACTURED BONE TO WALK IN 1 DAY, LEAVE THE HOSPITAL IN 1 WEEK, AND BE BACK AT WORK IN 1 MONTH. THE PATIENT AVOIDS POSSIBLE PERMANENT DISABILITY AND IS RETURNED TO MOBILITY. SEE SCHEDULE O ON HOW WE DISTRIBUTE APPROPRIATE ORTHOPAEDIC TECHNOLOGY.DISTRIBUTE APPROPRIATE ORTHOPAEDIC TECHNOLOGY:THE SIGN IM NAIL AND INTERLOCKING SCREW SYSTEM IS DESIGNED FOR USE IN HOSPITALS IN DEVELOPING COUNTRIES WHERE C-ARMS AND RELIABLE POWER ARE NOT AVAILABLE. SIGN ENGINEERS CONTINUALLY DEVELOP NEW ORTHOPAEDIC INSTRUMENTS AND IMPLANTS IN RESPONSE TO THE NEEDS DESCRIBED BY THE LOCAL SURGEONS. IN 2024, THE ELBOW PLATE BENDING TEMPLATE WAS RELEASED. THE ELBOW PLATE BENDING TEMPLATE IS USED TO CONTOUR SMALL BONE FRAGMENTARY PLATES, SUCH AS THE SIGN FX PLATES, TO MATCH THE ANATOMY OF THE DISTAL HUMERUS AND OLECRANON WHEN STABILIZING ELBOW FRACTURES. THE TEMPLATE CAN BE USED WITH NON-SIGN PRODUCTS (LIKE THE 3.5MM RECONSTRUCTION PLATES) AND BOTH BEFORE AND DURING SURGERY.WE SUPPLY NEW SIGN PROGRAMS WITH THE SIGN IM NAIL SYSTEM, WHICH SURGEONS USE TO REPAIR SEVERE FRACTURES IN THE FEMUR, TIBIA, AND HUMERUS. ONCE A PROGRAM HAS DEMONSTRATED ITS ABILITY TO REPORT THEIR CASES, INCLUDING ADEQUATE FOLLOW-UP THAT CONFIRMS THEIR RESULTS COMPLY WITH OUR EXPECTATIONS, THEY BECOME ELIGIBLE TO RECEIVE ADDITIONAL SIGN PRODUCTS, AS WELL AS IN-KIND DONATIONS RECEIVED FROM FOR-PROFIT ORTHOPAEDIC IMPLANT COMPANIES.IN 2024, WE DISTRIBUTED 27,107 SIGN NAILS TO 48 COUNTRIES. OUR AIM IS TO ENABLE THE POOR TO GAIN ACCESS TO AFFORDABLE ORTHOPAEDIC SURGERY, WHICH MEANS THE MAJORITY OF OUR IMPLANTS ARE DONATED FREE OF CHARGE TO THE PATIENT.WE STARTED 22 NEW SIGN PROGRAMS IN 2024. THE BREAKDOWN WAS AS FOLLOWS: AFRICA: 15 PROGRAMS ASIA: 6 PROGRAMS NORTH AMERICA: 1 (HAITI)WE HAVE ALSO BEGUN DEVELOPING A NEW KIND OF PROGRAM, FOCUSED ON PROVIDING EDUCATION AND IMPLANTS RELATING TO TREATING SPINE FRACTURES. THIS NEW PROGRAM IS REFERRED TO AS SIGN SPINE. WE STARTED SIGN SPINE PROGRAMS IN KENYA AND TANZANIA IN 2024 AND ARE PROJECTED TO START FIVE ADDITIONAL SIGN SPINE PROGRAMS IN THE COMING YEAR. AS OF DECEMBER 31, 2024, THE WORLD BANK INCOME CLASSIFICATIONS BY GNI FOR THE COUNTRIES WITH NEW SIGN PROGRAMS WERE AS FOLLOWS: LOW INCOME: 48% LOWER MIDDLE INCOME: 44% UPPER MIDDLE INCOME: 8%DISASTER AND CONFLICT RESPONSE:WE BELIEVE IN EQUALITY OF FRACTURE CARE FOR ALL, REGARDLESS OF GENDER, RELIGION, POLITICAL AFFILIATION, OR ANY OTHER IDENTITY. WE CONTINUE TO SUPPORT THE 17 SIGN PROGRAMS IN HAITI AS BEST AS WE ARE ABLE. THE ONGOING GANG VIOLENCE IN THE COUNTRY LIMITS OUR ABILITY TO PROVIDE REPLACEMENT SIGN IMPLANTS AND INSTRUMENTS AS AIRLINES ROUTINELY CANCEL FLIGHTS. WE CONTINUE TO COMMUNICATE WITH THE SURGEONS IN-COUNTRY AND SEND REPLACEMENT SIGN IMPLANTS AND INSTRUMENTS THROUGH AVAILABLE AVENUES AS THEY APPEAR.IN LATE 2024, A STUDENT-LED MOVEMENT OUSTED THE CURRENT PRIME MINISTER OF BANGLADESH. THE FALLOUT OF THE MOVEMENT RESULTED IN AN INCREASE IN VIOLENCE FROM VARIOUS INTERNAL GROUPS. A LOCAL SIGN SURGEON ALERTED US TO THE INCREASE IN FRACTURE PATIENTS IN THE WEEKS FOLLOWING THE OUSTING OF THE FORMER PRIME MINISTER AND REQUESTED ADDITIONAL SIGN NAILS AND INSTRUMENT SETS TO TREAT THE INFLUX OF PATIENTS. IN RESPONSE TO THEIR REQUEST, WE PROVIDE TWO ADDITIONAL SIGN SETS AND 130 SIGN NAILS TO ASSIST WITH THE INCREASED PATIENT LOAD.IN MYANMAR, THE EFFECTS OF THE MILITARY COUP ARE STILL FELT BY THE POOR POPULATION, AND ACCESS TO FRACTURE CARE IS CRUCIAL. WE CONTINUE TO SUPPORT THE SIGN PROGRAMS THERE WITH IMPLANTS AND INSTRUMENTS WHEN WE'RE ABLE TO SHIP TO THEM.WE ARE ALSO SUPPORTING MANY HOSPITALS IN AFGHANISTAN AS THEY NAVIGATE THROUGH THEIR TUMULTUOUS LANDSCAPE, AND WORK WITH LOCAL SURGEONS TO ENSURE THE AVAILABILITY OF FRACTURE CARE IS WIDESPREAD FOR THE POOR POPULATION. IN EARLY 2024, WE WERE ABLE TO START 2 NEW SIGN PROGRAMS IN AFGHANISTAN AND ARE LOOKING FORWARD TO WORKING WITH THEM IN THE FUTURE.GeographiesNot indicatedDatesJan 1, 2024 – Dec 31, 2024Source990No causes providedNo populations provided–$4.3MOrthopaedic Training and Capacity Building
WE BUILD SUSTAINABLE ORTHOPAEDIC CAPACITY IN LMIC BY EDUCATING LOCAL SURGEONS TO CARE FOR PATIENTS IN THEIR HOME COMMUNITIES. FOR 26 YEARS, SIGN HAS BEEN WORKING ALONGSIDE SURGEONS IN LMIC, RAISING ORTHOPAEDIC KNOWLEDGE AND SKILL. WE NOW RELY ON SIGN SURGEON MENTORS TO PROVIDE EDUCATION TO NEW SURGEONS. ONCE NEW SURGEONS ARE TRAINED, THEY RECEIVE THEIR OWN STARTER SET OF THE SIGN IM NAIL SYSTEM WITH TRAINING MATERIALS INCLUDED. THE TRAINING MANUALS ARE AUGMENTED BY ONLINE MENTORSHIP VIA THE SIGN SURGICAL DATABASE (SSDB). SURGEONS ARE REQUIRED TO ENTER CASES INTO THE SSDB IN EXCHANGE FOR A FREE RESUPPLY OF SIGN NAILS. EACH CASE IS REVIEWED BY AN ORTHOPAEDIC SURGEON FROM OUR BOARD OR EXPERIENCED SIGN SURGEON MENTORS. THEIR FEEDBACK ON EACH CASE IS SENT TO ALL ORTHOPAEDIC SURGEONS AT THAT HOSPITAL VIA EMAIL.WE PROVIDE ACCESS TO ORTHOPAEDIC TRAINING AND EDUCATION TO SURGEONS IN DEVELOPING COUNTRIES VIA FIVE PRIMARY CHANNELS:1. ONSITE VISITS BY LOCAL SURGEONS AND NORTH AMERICAN AND EUROPEAN SURGEONS. 2. EMAIL COMMUNICATIONS WITH SIGN HEADQUARTERS.3. DISCUSSION TOPICS AND EDUCATIONAL RESOURCES POSTED ON OUR WEBSITE, THE HUB.4. REVIEW OF CASES SUBMITTED TO THE SIGN SURGICAL DATABASE BY SENIOR ORTHOPAEDIC SURGEONS AND SIGN BOARD MEMBERS. 5. REGIONAL SIGN AND TRAUMA CONFERENCES, AS WELL AS THE ANNUAL INTERNATIONAL ORTHOPAEDIC CONFERENCE HELD AT SIGN HEADQUARTERS.THE OBJECTIVES FOR ALL MODES OF TRAINING ARE: 1) ENSURE SIGN SURGEONS UNDERSTAND THE SURGICAL TECHNIQUE FOR THE SIGN PRODUCTS IN THEIR HOSPITAL; 2) PROVIDE TRAINING ON CURRENT AND RELEVANT ORTHOPAEDIC PRINCIPLES; AND 3) PROVIDE TRAINING IN ORTHOPAEDIC AND TRAUMA PROCEDURES FOR INJURIES SUCH AS OPEN WOUNDS, LIMB DEFORMITY, PEDIATRIC, AND PELVIC.EXPAND TRAINING AND EDUCATIONAL OPPORTUNITIES:THE ANNUAL SIGN CONFERENCE WAS HELD IN SEPTEMBER 2024 AT SIGN HEADQUARTERS IN RICHLAND, WASHINGTON. THIS CONFERENCE PROVIDED A COMBINATION OF DIDACTIC LECTURES ON FRACTURE MANAGEMENT, CASE STUDIES, SEVEN CADAVER LAB SESSIONS, AND A SPECIAL FULL-DAY SESSION ON THORACIC SPINE.THE 2024 SIGN CONFERENCE FEATURED 62 SURGEONS FROM 26 COUNTRIES AND INCLUDED TWO NEW SESSIONS: A FIRST TIME ATTENDEE ORIENTATION AND A PILOT BIOSKILLS LAB ON HEMIARTHROPLASTY. THE FIRST TIME ATTENDEE ORIENTATION WAS ATTENDED BY 11 SURGEONS AND INCLUDED A TOUR OF SIGN HQ AND BREAKOUT SESSIONS TO FAMILIARIZE NEW ATTENDEES WITH OUR INSTRUMENTS AND IMPLANTS.THE BIOSKILLS LAB AND PROCEDURAL LEARNING CENTER, WHICH WAS COMPLETED IN EARLY 2022, CONTINUES TO BE A FOCAL POINT DURING THE SIGN CONFERENCE. THESE FACILITIES ALLOW CONFERENCE ATTENDEES TO EXPERIENCE HANDS-ON TRAINING FROM EXPERT CLINICAL EDUCATORS. THE LAB SESSIONS TEACH CRITICAL TECHNIQUES SUCH AS PELVIC FRACTURES/HEMIARTHROPLASTY, PROXIMAL FEMUR FRACTURES, ELBOW FRACTURES, ANKLE FRACTURES/FUSIONS, THORACIC SPINE, AND TIBIAL PLATEAU FRACTURES. WE CONTINUE TO DEVELOP OUR RELATIONSHIP WITH THE INSTITUTE FOR GLOBAL ORTHOPAEDICS AND TRAUMATOLOGY (IGOT). IN 2024, IGOT HOSTED THEIR THREE-DAY SURGICAL MANAGEMENT AND RECONSTRUCTIVE TRAINING COURSE (SMART) COURSE AT SIGN HEADQUARTERS AFTER THE CONCLUSION OF THE SIGN CONFERENCE. THIS ALLOWED NEARLY ALL CONFERENCE ATTENDEES TO ATTEND AND RECEIVE ADDITIONAL CADAVER TRAINING IN FLAPS FOR SOFT TISSUE RECONSTRUCTION AND DEFORMITY CORRECTION. THE SMART COURSE INCLUDED A "REAL-LIFE" SURGICAL CASE SIMULATION, PROVIDING ATTENDEES WITH THE OPPORTUNITY TO APPLY THE SKILLS THEY LEARNED OVER THE WEEK INTO PRACTICE. IGOT ALSO HELD A CLINICAL RESEARCH SYMPOSIUM FOCUSED ON CONDUCTING STUDIES TO ADDRESS CRITICAL TREATMENT QUESTIONS FACED BY THE ATTENDEES' SPECIFIC PATIENT POPULATIONS.IGOT ALSO PROVIDES REGIONAL TRAINING IN OTHER SURGICAL TECHNIQUES TO SIGN SURGEONS IN EAST AFRICA AND NEPAL.THE 1ST INTERNATIONAL SIGN CONFERENCE WAS HELD AT SHAHAB ORTHOPAEDIC HOSPITAL IN PESHAWAR, PAKISTAN IN APRIL 2024. MORE THAN 60 AFGHANI AND PAKISTANI SURGEONS ATTENDED AND DOZENS MORE PARTICIPATED VIA TELECONFERENCE. MODELING THE FORMAT AFTER THE ANNUAL SIGN CONFERENCE IN RICHLAND, WA, DR. FASEEH SHAHAB ORGANIZED LOCAL SURGEONS TO BE THE PRIMARY FACULTY, PROVIDING LECTURES THAT HIGHLIGHTED THEIR EXPERTISE, RESEARCH, AND EXPERIENCE.IN ADDITION, EXPERT SURGEONS FROM AROUND THE WORLD PRESENTED VIA ZOOM, INCLUDING DR. LEWIS ZIRKLE, SIGN PRESIDENT AND FOUNDER, AND DR. DAVID SHEARER, VICE PRESIDENT OF THE SIGN BOARD, DR. AUNG THEIN HTAY FROM MYANMAR, AND DR. ISMAIL WARDAK FROM AFGHANISTAN.SIGN AND IGOT PARTNERED WITH THE MUHIMBILI ORTHOPAEDIC INSTITUTE TO HOLD THE 9TH ANNUAL TANZANIA SMART COURSE IN JUNE 2024. OVER 140 SURGEONS ATTENDED THE COURSE FOCUSING ON A MIX OF DIDACTIC LECTURES AND DEMONSTRATIONS FOR ORTHOPAEDIC SURGEONS AND RESIDENTS. COURSE TOPICS INCLUDED HIP AND KNEE, UPPER EXTREMITY, PELVIS AND ACETABULUM, LIMB DEFORMITY, OPEN FRACTURES, AND SOFT-TISSUE FLAPS.THE HUB, SIGN'S WEBSITE FOR EDUCATIONAL RESOURCES FOR SURGEONS, CONTAINS VIDEOS, ARTICLES, DISCUSSIONS, AND MORE TO PROVIDE ONGOING LEARNING OPPORTUNITIES FOR SURGEONS ACROSS THE GLOBE.THE SIGN IT DEPARTMENT CONTINUES TO MAKE IMPROVEMENTS TO THE SIGN SURGICAL DATABASE WEBSITE, WHICH IS THE BACKBONE OF REPORTING AND RESEARCHING SURGICAL CASES. OUR IT DEPARTMENT HAS IMPROVED THE STUDIES AND RESEARCH TOOLS ON THE DATABASE TO ACCOMMODATE USER NEEDS AND UPDATED THE BACK-END FRAMEWORK OF THE DATABASE TO IMPROVE OVERALL EFFICIENCY.WE CONTINUE TO PARTNER WITH BLACK LION HOSPITAL, IN ADDIS ABABA, ETHIOPIA ON THE FIRST EAST AFRICAN PELVIC FELLOWSHIP PROGRAM. SINCE THE BEGINNING OF THIS PARTNERSHIP, 9 SURGEONS FROM 5 COUNTRIES HAVE COMPLETED THEIR FELLOWSHIP. OUR TRAVELING SET PROGRAM MODEL WAS A CONTINUED SUCCESS IN ETHIOPIA AND TANZANIA. IN THIS MODEL, THE MENTOR SURGEON MANAGING THE SET IDENTIFIES A HOSPITAL THEY BELIEVE HAS THE POTENTIAL TO SERVE MANY PATIENTS. THE MENTOR SURGEON THEN TRAVELS TO THE HOSPITAL AND TRAINS THE SURGEONS IN THE SIGN TECHNIQUE AND DATABASE REPORTING. AFTER THE TRAINING IS COMPLETED, THE SET IS STATIONED AT THE HOSPITAL FOR THREE MONTHS. IF THE HOSPITAL REPORTS AT LEAST 25 CASES WITHIN THE THREE-MONTH PERIOD, THEY ARE ELIGIBLE TO APPLY TO START THEIR OWN SIGN PROGRAM. WE STARTED 3 NEW PROGRAMS IN ETHIOPIA AND 3 NEW PROGRAMS IN TANZANIA VIA THE TRAVELING SETS IN 2024. BASED ON THE SUCCESS OF THE PREVIOUS TRAVELING SETS, WE HAVE ADDED NEW TRAVELING SET PROGRAMS IN TANZANIA AND GHANA.GeographiesNot indicatedDatesJan 1, 2024 – Dec 31, 2024Source990No causes providedNo populations provided–$1.3MSign Spine Program
PEOPLE LIVING IN LMIC CANNOT ACCESS SPINE CARE WHEN IT IS NOT AVAILABLE IN THEIR COMMUNITY. THE INCIDENCE OF TRAUMATIC SPINAL INJURIES IN LMIC IS ESTIMATED TO BE 13.7 CASES PER 100,000 PERSONS. SIGN HAS IMPLEMENTED A SIGN SPINE PROGRAM AT TWO HOSPITALS IN TWO COUNTIES. WE HAVE PLANS TO EXPAND INTO THREE MORE COUNTRIES WITH A TOTAL OF 10 SITES. WE HAVE THREE GOALS: 1. IMPROVE ACCESS TO SAFE SPINE SURGERY WORLDWIDE. 2. IMPROVE ACCESS TO SPINE SURGICAL EDUCATION AND TRAINING. 3. IMPROVE ACCESS TO AFFORDABLE SPINE IMPLANTS. SIGN IS PARTNERING WITH TEACHING HOSPITALS IN CANADA TO PROVIDE YEAR-LONG FELLOWSHIPS FOR SURGEONS FROM LMIC HOSPITALS. THE GRADUATES WILL RETURN TO THEIR HOSPITALS TO PROVIDE SAFE, EFFECTIVE CARE FOR PATIENTS WITH SPINE INJURIES, AS WELL AS PROVIDE TRAINING TO OTHER SURGEONS.GeographiesNot indicatedDatesJan 1, 2024 – Dec 31, 2024Source990No causes providedNo populations provided–$41.7K
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