The SIGN Solution
Education + Implants = Healing
In 1999, Dr. Lewis G. Zirkle founded SIGN Fracture Care to pursue his vision of creating equality of fracture care throughout the world.
SIGN offers a unique, end-to-end solution to help hospitals in low-income countries provide safe and effective fracture care. We train local surgeons in techniques to care for patients with broken bones, and we equip the surgeons with orthopaedic instruments and implants they need to put the training into action. SIGN Instruments are specifically designed to be used in low-resource settings and are donated at no cost to hospitals or patients, making fracture surgery accessible and affordable for people in poverty.
By providing orthopaedic implants and education to surgeons working in low- and middle-income country (LMICs) hospitals, SIGN jump-started the building of orthopaedic capacity in these countries. Surgeons, who previously did not have access to the instruments and implants they needed, are now equipped to provide immediate and effective care for their patients. SIGN Surgery enables most patients with a broken leg to stand and walk with crutches the day after surgery, return home in a week, and be back to work in 1-2 months.
Click here to learn more about Dr. Zirkle and the history of SIGN.
SIGN Patient Minase (center) stands with his father (left) and SIGN Surgeon Dr. Chernet Leka (right) six weeks after his surgery.
Ethiopia, 2026.
Kumi, Uganda (2016)
Design.
SIGN Nails, medical implants that stabilize broken bones, are specifically designed for use in resource-limited hospitals.
Dr, Zirkle and a team of engineers worked to create an implant system that did not rely on expensive machinery to use.
Their solution was creating the SIGN Target Arm and Slot Finder, enabling a surgeon to place a nail in the bone completely by hand.
SIGN Headquarters in Richland, Washington (2026)
Manufacture.
Emmett is a detail-oriented instructor who’s spent the past decade helping people develop new tools, habits, and mindsets. Their approach is clear, practical, and always infused with curiosity and care.
Manawan, Pakistan (2021)
Donate.
Staying true to Dr. Zirkle’s vision, all SIGN Instruments and Implants are donated at no cost to surgeons and hospitals in LMICs.
SIGN Nails can then be provided to patients at no cost, allowing access to care that was previously unavailable.
Driven by passion
Our journey has been anything but ordinary. Through every step, we've focused on staying true to our values and making space for thoughtful, lasting work.
This isn’t just a business—it’s a reflection of what we believe in. We’re here to create work that matters, led by a shared commitment to quality and care.