title: The role of SIGN in the development of a global orthopaedic trauma database.
abstract: BACKGROUND
  The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries.
  
  
  OBJECTIVE
  We describe the information in the SIGN database then address two questions: In the context of the design and implementation of a global trauma database, what lessons does the SIGN database teach? Does the SIGN program have a role in the evolution of a wider global system?
  
  
  METHODS
  The SIGN database is Internet based. After treating a patient with a SIGN nail surgeons enter radiographs and details of the case.
  
  
  RESULTS
  Over 26000 cases are in the SIGN database. The database has been used as a source of cases for followup studies. Analysis shows the data are of sufficient quality to allow studies of fracture patterns but not for outcome studies or bone measurement. WHERE DO WE NEED TO GO?: A global database with more comprehensive coverage of injuries, causes, treatment modalities and outcomes is needed. HOW DO WE GET THERE?: The SIGN database itself will not become a global trauma database (GTD) but the personnel of the SIGN program have much to offer in the design and adoption of a GTD. Studies of suitable methods of data collection and the incentive to use them are required.
authors.affiliation: Department of Orthopaedic Surgery, University of British Columbia, 198 Waddington Drive, Kamloops, Vancouver, BC, V2E 1M4, Canada. mylesclough@shaw.ca
authors.forename: John F
authors.initials: JF
authors.lastname: Clough
authors.forename: Lewis G
authors.initials: LG
authors.lastname: Zirkle
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Schmitt
mesh_terms: D001858:Bone Nails; D003299:Cooperative Behavior; D019992:Databases as Topic; D003906:Developing Countries; D005592:Fracture Fixation / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007391:International Cooperation; D038622:Internationality; D020407:Internet; D009939:Organizations, Nonprofit; D016730:Program Development; D015397:Program Evaluation; D011859:Radiography; D016896:Treatment Outcome