title: 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.
abstract: BACKGROUND
  The Surgical Implant Generation Network (SIGN) supplies intramedullary (IM) nails for the treatment of long bone fractures free of charge to hospitals in low- and middle-income countries (LMICs). Most operations are reported to the SIGN Online Surgical Database (SOSD). Follow-up has been reported to be low, however. We wanted to examine the pattern of follow-up and to assess whether infection rates could be trusted.
  
  
  METHODS
  The SOSD contained 36,454 IM nail surgeries in 55 LMICs. We excluded humerus and hip fractures, and fractures without a registered surgical approach. This left 34,361 IM nails for analysis. A generalized additive regression model (gam) was used to explore the association between follow-up rates and infection rates.
  
  
  RESULTS
  The overall follow-up rate in the SOSD was 18.1% (95% CI: 17.7-18.5) and national follow-up rates ranged from 0% to 74.2%. The overall infection rate was 0.7% (CI: 0.6-0.8) for femoral fractures and 1.2% (CI: 1.0-1.4) for tibial fractures. If only nails with a registered follow-up visit were included (n = 6,224), infection rates were 3.5% (CI: 3.0-4.1) for femoral fractures and 7.3% (CI: 6.2-8.4) for tibial fractures. We found an increase in infection rates with increasing follow-up rates up to a level of 5%. Follow-up above 5% did not result in increased infection rates.
  
  
  CONCLUSIONS
  Reported infection rates after IM nailing in the SOSD appear to be reliable and could be used for further research. The low infection rates suggest that IM nailing is a safe procedure also in low- and middle-income countries.
authors: Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. svenyoung@gmail.com
authors: Sven
authors: S
authors: Young
authors: Stein Atle
authors: SA
authors: Lie
authors: Geir
authors: G
authors: Hallan
authors: Lewis G
authors: LG
authors: Zirkle
authors: Lars B
authors: LB
authors: Engesaeter
authors: Leif I
authors: LI
authors: Havelin
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails / Q000009:adverse effects* / Q000191:economics; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000191:economics / Q000592:standards; D014943:Global Health; D006801:Humans; D007182:Income; D020407:Internet; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013978:Tibial Fractures / Q000601:surgery; D055815:Young Adult