‘One AAOS surgeon can change the world’
By Carolyn Rogers
AAOS honors Lewis G. Zirkle, Jr., MD—an ‘ultimate humanitarian’—with the 2007 Humanitarian Award
A few years ago in Honduras, a slight, 15-year old boy named Elver was in serious trouble. Three weeks earlier, he’d fractured his left femur while playing soccer. In the United States, this might mean he’d miss playing his favorite sport for the rest of the season. For Elver, however, this was a devastating injury—not only for him, but for his mother and three sisters who depended on his earnings as a field worker for their survival. In pain, he sat helplessly in a hospital holding ward—waiting for a bed to open up in a facility that wasn’t even equipped to treat such a severe orthopaedic injury.
He’d just joined 20 million others in the developing world who suffer severe orthopedic trauma every year. Like them, Elver’s options were grim: amputation, severe deformity, life as an invalid dependent on family members for sustenance, or death.
Fate steps in
Fortunately for Elver, a lucky convergence of people, time, place and technology spared him from making such a choice. On a Mercy Ships vessel docked in a nearby harbor, Lewis G. Zirkle, Jr., MD, had just begun training local surgeons in the use of a new and inexpensive surgical technology he had developed. Elver was to become one of the first beneficiaries of the Hondurans’ newly acquired technology—his future reclaimed through the use of a stainless steel rod, inserted into the central canal of his splintered femur. Elver was able to walk just one day after surgery, and returned to a normal life a few weeks later.
Elver is only one of more than 20,000 people in 43 developing countries who have benefited from this technology, at no cost to them, since Dr. Zirkle founded the Surgical Implant Generation Network (SIGN)—a humanitarian organization dedicated to creating equality of fracture care throughout the world.
With such a record, therefore, it isn’t surprising that the Academy was inundated with glowing letters of commendation and support for Dr. Zirkle, when the call went out for the 2007 AAOS Humanitarian Award nominations. This annual honor recognizes AAOS fellows who have distinguished themselves through outstanding musculoskeletal activities at home or abroad.
Yesterday, the Academy bestowed its 2007 Humanitarian Award on Dr. Zirkle, in recognition of his lifetime of commitment to alleviating musculoskeletal suffering worldwide. A $5,000 donation to SIGN accompanied the award.
“This award is given in recognition of those among us who epitomize volunteerism and giving back to our communities and the world,” said Richard P. Kyle, MD, 2006-2007 president, as he presented the award. “Dr. Zirkle’s work dramatically alleviates human suffering by restoring health to individuals with disabling fractures. Today we honor an ultimate humanitarian.”
The inspiration for SIGN
SIGN is a global, non-profit organization of orthopaedic surgeons, engineers and other support staff who design and manufacture medullary nails with interlocking screws for the femur, tibia and humerus. The SIGN nails meet the needs of orthopaedic surgeons in developing countries because they do not require power tools for implantation or imaging to accomplish the interlock.
“Until recently, treatment with intramedullary (IM) nails—the state-of-the-art method for treating many serious fractures—has not been available to the poor in developing countries,” says Dr. Zirkle. “One of SIGN’s goals is to make this the worldwide standard for fracture treatment.”
Although SIGN was officially incorporated in 1999, its mission began back in 1968, when Dr. Zirkle was serving as an Army orthopaedic surgeon in Vietnam. The suffering he saw among the Vietnamese people prompted him to volunteer for extra duty as a civil actions officer. After a long shift of operating on soldiers, he ventured out into the countryside to care for people in rural villages.
At the end of his tour, Dr. Zirkle returned to the United States and established a practice. Several years later, he was haunted by the troubles of people like those he’d met in rural Vietnam, whom he has called “the gray people”—people ignored by others.
In the 1980s, his compassion led him to Indonesia, which at the time had just one orthopaedic surgeon for its entire population of 80 million. By the time he left Indonesia, “We had trained 57 surgeons and had established four training centers,” he says.
“Teaching is not enough”
In the 1990s, while visiting a hospital on the Indonesian island of Sumatra, Dr. Zirkle and his Orthopaedics Overseas colleagues were shocked to find a man who had spent the past three years in traction, wasting away in a hospital room.
“Speaking with this man was a sentinel event,” Dr. Zirkle says. “It inspired us to change our priorities.”
Although the doctors in Indonesia were skilled and eager to learn new techniques, they didn’t have the implants necessary to fix the fractures, Dr. Zirkle says. “We can teach, but if they do not have the materials to do the surgery, it’s for naught.”
It became evident that ongoing education, communication and a reliable supply of implants and other surgical materials needed to be available for improved fracture treatment to succeed.
Vision: Equality of fracture care
Working with like-minded physicians, surgeons and concerned citizens, Dr. Zirkle soon laid the groundwork for his vision of providing an all-encompassing system of training, hardware, follow-up and repeat visits to orthopaedic surgeons in developing countries. These would become the guiding principles by which all SIGN projects would be established.
Dr. Zirkle traveled to Southeast Asia in May 1999 to initiate four SIGN pilot projects in public hospitals—one each in Thailand and Indonesia, and two in Vietnam. He assisted in numerous surgeries to train the partnering physicians in the SIGN techniques. These four pilot projects laid the foundation for additional, ongoing partnerships in other parts of the world.
The results have been awe-inspiring. What began as little more than a handful of donated surgical items and borrowed office space now includes a staff of 12 full-time employees and a state-of-the-art manufacturing facility for producing the SIGN IM nails, screws, jigs, and other hardware necessary for fracture care treatment in developing countries.
“After doctors are trained in the system at one SIGN project, they’re inspired to establish SIGN projects at their own hospitals,” Dr. Zirkle explains. “It keeps expanding from there.”
How it works
SIGN training, instruments and a continuing supply of surgical implants are provided free to host surgeons, enabling them to provide quality fracture treatment for the poor. In the past eight years, SIGN doctors have performed more than 20,000 operations. The SIGN network is growing by 25 percent a year and now has 110 programs in 43 countries.
SIGN’s manufacturing facility is capable of producing about 80 nails per day, along with the accompanying interlocking screws. The implantation instruments and about 100 nails are donated to each new SIGN project at a cost of about $15,000. Once these nails are used, new nails and screws are supplied to each SIGN site free of charge.
“Although Dr. Zirkle gratefully accepts philanthropic donations to help offset the substantial costs of labor and manufacturing, he bears the majority of this huge and ongoing financial outlay, says orthopaedic surgeon John R. Perry, MD. “Luckily for the nearly 1,000 SIGN trained surgeons, Dr. Zirkle views this as a privilege and his responsibility rather than a burden.”
Answering the call when disaster strikes
In addition to the growing number of SIGN projects around the world, Dr. Zirkle is always quick to respond to natural disasters, wherever they might occur.
He has made multiple visits to Asian disaster zones, including the December 2004 tsunami, (see the June 2005 Bulletin article “Orthopaedists help tsunami-ravaged hospitals, victims”) and the October 2005 massive earthquake in the mountains of north Pakistan. He was overwhelmed by the devastation facing survivors.
“That earthquake was horrible fracture-wise because the homes were made out of concrete or stone,” he explains.
His work with SIGN is both a calling and a passion for him, Dr. Zirkle says. “I think it’s so unfair for someone to get their allotted time on this Earth and not be able to enjoy it,” he says. “I’m tremendously lucky, and I believe I should pass some of that enjoyment to others.”