I just returned from a two-week trip to Vietnam, Thailand, and Bangladesh.

Vietnam

While I was in Vietnam, Cho Ray Hospital in Ho Chi Minh City hosted the first ever SIGN Conference, attended by about 100 surgeons. Six papers, all reporting good results, were presented by Vietnamese SIGN surgeons.

The professors who set medical policy in Vietnam have all endorsed the SIGN approach. The conference featured a live SIGN surgery that all participants were able to view by closed circuit video.

Many of the surgeons attending the conference have asked to have SIGN equipment provided for use in their hospitals, so we will establish training programs in Vietnam and choose teachers who will evaluate these surgeons carefully. We will then ship SIGN equipment to the new project sites when they are ready.

A new SIGN project has been started at Nhan Dan Gia Dinh Hospital. A SIGN nail surgery was done there while I was in Vietnam. Dr. Tuan from Cho Ray will help implement the program there.

We have now established a procedure through which existing SIGN centers will teach surgeons from other hospitals. I have carefully chosen surgeons with good judgment to facilitate this effort. When a hospital is certified as SIGN qualified, we will then supply SIGN instruments and implants.

I visited Binh Duong Hospital after visiting Ho Chi Minh City. For convenience, I was transported by ambulance, and arrived at the hospital coincidental to a severe accident victim. The case was a 17-year-old girl with two fractures in her tibia and femur. We put SIGN nails in both femur and tibia. It was especially important to stabilize the fracture because her foot did not have a good blood supply. The patient was responding well to the treatment two days after surgery. While at Binh Duong we did many other SIGN nail surgeries including nails going down the hip from above. I learned many surgical tips and techniques from the excellent Vietnamese surgeons who have done many SIGN procedures and are very proficient using the SIGN technology.

Thailand

I then left for Thailand, where we met with Dr. Suthorn. The bag filled with seventy pounds of SIGN instruments and implants that we sent for delivery to two new projects in Thailand arrived late, giving us all some reason for anxiety. Dr. Apikit received it upon its arrival.

We received pictures of the X-rays of the second case in Chiang Mai; it was a very severe fracture with two fractures in the femur and one in the tibia, all on the same side. The surgery went well.

Bangladesh

On my arrival at the airport in Bangladesh, I felt privileged to be singled out for personal escort through customs. Each morning began with a one-hour conference at which patients admitted for surgery that day were presented and results from the previous day’s surgery were reviewed. We discussed many cases and surgical philosophy, as well.

We then went for a cup of tea in the lounge and discussed other matters.

We did many SIGN nails on the tibia and the femur, and two of the hip. Surgeons there have expanded the indications for SIGN nail, which means that we must design changes to accommodate the expanded use in the femur and hip. On reflection, I have come to understand that: (1) SIGN nail treatment is the only treatment to which these patients have access, and (2) the expanded uses are working out well. They will follow these cases closely. A number of surgical residents have been assigned: (1) to monitor fractures of the different parts of the femur and tibia, and (2) to compare results with other treatments, so we will have solid data for future evaluation of SIGN’s products.

SIGN will develop: (1) shorter nails for the distal femur, and (2) a nail designed for antegrade placement down the hip. These were already “on the drawing board” for future development but we will now accelerate their development because these kinds of fractures are already being treated with SIGN nails anyway.

The SIGN-Dhaka team performed its first surgery in its new OR suite at RIHD. The surgery suite was actually built five years ago but was never used because it could not be equipped. The director, Professor Aolad, has designated one room for SIGN surgeries, so we will be able to get fractures with the skin open to the operating room faster. The facility will also serve as a teaching center for surgeons from throughout Dhaka, the rest of Bangladesh, and other countries. Equipment needed includes anesthesia machines, hepa-air filters, cautery, orthopaedic instruments, (including drills) and, of course, SIGN instruments and implants. This Fracture Center is something about which I have long dreamed . . . and SIGN is pleased to assist in its development.

I see a very bright future for orthopaedics in RIHD and Bangladesh. The surgeons demonstrate, show good judgment, and they evaluate their results carefully.

SIGN is gaining increased recognition as a superior treatment for most tibia and femur fractures in Vietnam, Thailand, and Bangladesh. As I noted above, the new program in Chaing Mai is especially encouraging.

I was exhilarated by this trip and thankful that I can be a part of SIGN’s treatment of so many severely injured patients.