SIGN Fracture Care International

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; 3) provide training in orthopaedic and trauma procedures for injuries such as open wounds, limb deformity, pediatric, and pelvic and 4) begin the planning process to start Sign spine.expand training and educational opportunities:the annual Sign conference was held in october 2022 at Sign headquarters in richland, Washington after a two-year hiatus. This conference provided a combination of didactic lectures on Fracture management, case studies, and six cadaver lab sessions. With an eye on the dwindling global pandemic and uncertainty around International travel, we decided to provide specialized training to a limited number of the senior Sign surgeons, with the hope that they would impart this knowledge on their fellow Sign surgeons when they return to their home countries. As a result, 27 Sign surgeons from 16 different countries attended the 2022 Sign conference.in addition, the 2022 Sign conference featured the inaugural use of the new bioskills lab and procedural learning center, which was completed in early 2022. These new facilities, coupled with a smaller group of conference attendees, allowed us to host more cadaver lab sessions. The lab sessions covered critical topics such as pelvic fractures, proximal femur fractures, elbow fractures, ankle fusions, and soft tissue wound coverage. This conference also marked the first cadaver lab session on cervial spine. We continue to partner with the institute for global orthopaedics and traumatology (igot) who provides additional cadaver training in flaps and deformity correction in their two-day smart course after the Sign conference. Igot also provides regional training in other surgical techniques to Sign surgeons in east africa and nepal.in 2020, in partnership with igot, we launched the successful Sign trauma sessions webinar series. These webinars are held monthly via zoom and recorded for those surgeons who cannot attend live. Nearly every session includes faculty who are Sign surgeons. The Sign trauma sessions give Sign surgeons a chance to share their knowledge and expertise with their colleagues and discuss relevant topics in trauma Care such as humerus fractures, pediatric fractures, soft tissue wound coverage, and pelvic fractures. In 2022, we had 10 webinars which reached more than 1,100 Sign surgeons. 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. The upgrades allowed our team to ask questions only of certain programs, giving us the ability to create limited enrollment studies, and improved site security.we continue to partner with black lion hospital, in addis ababa, ethiopia on the first east african pelvic fellowship program. In 2022, they trained 3 ethiopian fellows who were then able to return home and put their new skills into practice in their local community.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 10 cases within the three-month period, they are eligible to apply to start their own Sign program. In 2022, we addded two additional traveling sets, one in tanzania and one in ethiopia. Due to a limitation on some of our instruments there were only two new Sign programs started using the teaching set model. However, we are looking forward to make up the difference in 2023.

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 2021, Sign engineers developed one new product and made design improvements to one instrument to assist in a variety of orthopaedic surgeries. The new product was an l-handle screw extractor, designed to remove shoulder cap screws from the l-handle when broken off inside. And the shoulder cap screw was re-designed to increase usage and minimize the ability for operating staff to over torque the screw, which can lead to breakage.we supply new 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 2022, we distributed 28,278 Sign nails to 57 countries. Our aim is to enable the poor to gain access to affordable orthopaedic surgery, which means that the majority of our implants are donated free of charge to the patient.we started 29 new Sign programs in 2022. The breakdown was as follows: africa: 11 programs asia: 2 programs europe: 16 (ukraine conflict)as of december 31, 2022, the world bank income classifications by gni for the countries with new Sign programs were as follows: low income 40% and lower middle income 60%. Disaster and conflict response:we believe in equality of Fracture Care for all, regardless of gender, religion, political affiliation, or any other identity. Since the beginning of the war in ukraine, we partnered with ukrainian surgeons and like-minded organizations to get the Sign nails and instruments into the hands of the doctors on the ground. We have sent Sign sets to 15 hospitals throughout ukraine, along with over 900 Sign nails (including Sign hip nails and pediatric nails), 19 large external fixator sets, small and large fragment sets, and many other general surgery consumables. To provide additional resources for the ukrainian surgeons, we translated an introduction to Sign presentation into ukrainian and added ukrainian subtitles to our animated technique video. We continue to communicate with these surgeons in ukraine, and we are preparing shipments to resupply their hospitals with Sign implants as needed.there was a peace treaty signed between the ethiopian government and tigray people's liberation front. We've received requests from several affected Sign programs at frontline hospitals who saw an increase in casualties related to this conflict. At the time of writing this report, we have sent 6 sets of large external fixators, 1 Sign instrument set, and 90 extra nails to ethiopian Sign programs who are treating the wounded. We continue to coordinate with our ethiopian Sign programs to ensure these programs have the Sign instruments and Sign nails they need to treat their patients.in august, torrential monsoon rains caused the most severe flooding in pakistan's recent history. Unicef reported that 33 million people were affected by the heavy monsoon rains. In response, we sent a Sign set and 50 nails to a Sign surgeon in larkana, pakistan, to assist with the injured patients he was receiving at his hospital.since the transfer of power to the taliban in afghanistan, travel in and out of the country has yet to normalize. This has greatly affected our ability to send nails to the local Sign programs. In late november 2021, we were able to send a shipment via an air freight company. Now that we have found a reliable shipping route into afghanistan, we continue to supply our Sign surgeons with the implants they need to treat the injured poor.sign spine: a team of spine surgeons from the us and canada are implementing a multi-site project to establish a Sign spine program. By the end of 2022, the Sign spine program had raised the funds to purchase initial spine implants and instrumentation for two hospitals; one in kenya and the other in tanzania. They have also identified two surgeons who will attend a one-year orthopaedic/neurosurgery spinal fellowship at mcmaster university in canada. The tanzania program is expected to begin by the end of 2023 and the kenya program will begin in july 2024.