We visited Guatemala to see the SIGN programs at Roosevelt Hospital and San Juan de Dios hospital. We were informed that three years ago, before SIGN came to Guatemala City, fractures of leg and arm were treated with pins that went through the bone and out the skin and connected by rods. This is called external fixation. Since SIGN has been used, fractures are treated transiently by external fixation or immediately by SIGN technique. This means the patient can arise from their bed the day after surgery and go home in a few days. This change in protocol has helped so many patients.

In Roosevelt Hospital we operated with the residents on a variety of patients. These included a 14-year-old boy with both femurs fractured and an older homeless man with a fracture of his lower leg which had not healed. We were very impressed with the residents' ability and receptiveness to learning. Residents from Honduras and El Salvador as well as Guatemala were present. We operated several days at Roosevelt Hospital and proceeded to work with Dr. Berrios at San Juan de Dios Hospital.

Dr. Berrios is a very gentle person who leads by example. One of the patients we operated on was a man she passed each day selling items in the market. He had been unable to walk for many years because his fractured tibia had not healed. He had been operated on many times and had a six-inch defect between the bone ends because the bone had become infected. We placed methyl methacrylate between the bone ends after we had mixed it with antibiotic with the hope that he could decrease the infection and have bone transport. Bone transport is a process of moving sections of bone to correct defects. We're very interested in developing better ways to do this because of the many injured civilians that have this problem in Iraq.

See the December 2007 newsletter on the website for pictures.