Fixing Broken Bones in the Developing World: Tri-Cities Nonprofit Develops Simple Technique To Help Healing

A tiny nonprofit organization in Richland, WA, has developed a simple, elegant fix for one of the big health problems in the developing world. A group that calls itself Sign has found a way to properly treat broken bones that people suffer in car accidents—like how it’s done in the U.S.—but without any of the expensive equipment we take for granted in emergency rooms.

The organization, formally called Surgical Implant Generation Network, has developed an “incredible device” that few people are aware of, says Paul Labarre, a technical officer with Seattle-based PATH, a nonprofit developer of global health technologies. Sign has an FDA-approved surgical nail that stabilizes broken bones, and can be fastened into place with bone screws by any physician with a little training.

This sort of procedure happens all the time in U.S. emergency rooms, so we barely stop to think about it. Such a pin placement usually costs $1,200, and holes need to be drilled for screws to anchor it in place—a procedure that requires an X-ray imaging machine that costs $150,000, says Jeanne Dillner, Sign’s CEO. The nonprofit has a different idea. Its system is designed so doctors can place the nails inside the bone just like in the U.S., and drill holes to properly align the stabilizing screws based on feel, without the help of an expensive machine that doesn’t exist in many parts of the developing world. The organization makes the nails at a cost of about $100 apiece, and donates them all, Dillner says.

“It doesn’t have the glitz and glamour of other global health issues,” says Labarre. “But it’s a big challenge.”

This is already making a big impact, Labarre says. Sign, founded in 1998 by Lewis Zirkle Jr., a Richland-based orthopedic surgeon, has already trained about 3,000 doctors in 49 countries in how to use its patented nails, and the procedures have been performed more than 40,000 times. And that only represents a tiny slice of the problem. As many as 50 million people in the developing world suffer traumatic injuries in automobile or work accidents each year, according to World Health Organization estimates. Usually, those patients end up laying in a hospital bed for months while the break never properly heals, Labarre says. Even more eye-popping is this stat: road traffic accidents alone kill more people between the prime ages of 15 to 44 than HIV, tuberculosis, and malaria combined.

signboneI wouldn’t actually be too surprised. I recently got back from a mountain climbing trip to Mexico with two college friends, and without a doubt, the most harrowing experience of all was having to drive on that country’s back roads and even the major highways. Maybe that’s why PATH’s stats on car accidents grabbed my attention. (For the record, our rental car made it back to the Mexico City airport unscathed.)

PATH is well-known for its efforts to implement high-tech and low-tech solutions to global health problems. It gets more money and attention for its efforts to develop novel vaccines, or solve malnutrition problems with things like fortified rice. Even though PATH hasn’t gotten any funding from the Bill & Melinda Gates Foundation or government sources to improve trauma care, it is exploring ways to help amplify what groups like Sign are doing, Labarre says.

The inspiration behind Sign came when Zirkle was traveling in Indonesia in the late ’80s to train physicians there on bone-fixing techniques, Dillner says. He found a patient who was lying in traction for three years with a broken bone, because he couldn’t afford a modern implant, and the hospital couldn’t afford it either. Zirkle, the son of the founder of Spokane, WA-based Key Tronic (NASDAQ: [[ticker: KTCC]]), obviously has some entrepreneurial blood, and he decided to go on a business mission. He aimed to persuade big medical device companies that make modern bone pins, like Stryker (NYSE: SYK) and Smith & Nephew (NYSE: SNN), to help him make low-cost implants for broken bones.

“The light bulb really went on for Dr. Zirkle,” says Dillner. “Everything he did for training wasn’t going to be effective unless he could produce a low-cost supply of implants.”

It turned out that none of the big companies were interested, Dillner says. So in 1999 he Zirkle decided to develop the implants himself, in a nonprofit organization. Since the start, Sign has been heavily bankrolled by Zirkle himself, and other orthopedic surgeons in his network, who now support 20 employees and an annual budget of $2 million, she says.

Sign has grown to the point that its devices helped 15,000 people recover from trauma last year, and it wants to triple that annual number in the next three to five years, Dillner says. “Our goal is that a doctor in Nairobi can provide the same quality of care for a fracture patient as a doctor can at Harborview,” she says. (Harborview is the main trauma center in Seattle.)

Sign is now branching out with a second kind of simple device that can help patients with hip fractures in the developing world, Dillner says. Her organization is getting help here from PATH, which has bioengineers that are doing repeated stress tests that mimic the gait of a person walking with one of the implants. This could be the difference between being crippled and being able to walk for huge numbers of patients, Dillner says.

PATH’s Labarre was charged with starting up this trauma program about six months ago, and he sounds fired up. The organization is brainstorming now about ways to get Sign’s devices more broadly used, and to set up sustainable business models for companies in developing countries to run with other promising ideas. A couple examples include encouraging greater use of motorcycle helmets, and prosthetic devices for people who lose limbs.

“We really want a small portfolio of projects here because we see a dire need,” Labarre says. “This has been largely ignored, and if it continues to be, we’re going to continue to see an increase in traumatic injuries.”

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