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.
Click here to learn more about SIGN Implants and Instruments.
SIGN Headquarters in Richland, Washington (2026)
Manufacture.
Today, we have the capacity to produce more than 30,000 SIGN Implants and enough instrument sets for 25 new SIGN Programs every year.
True to the culture inspired by Dr. Zirkle, we continually innovate our manufacturing processes and capabilities to meet growing needs.
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.
Surgeons Teaching Other Surgeons
All of SIGN’s efforts support surgeons who live and work in LMICs. Unlike other organizations who provide medical mission trips to impoverished areas, SIGN is designed to empower local experts who are in the hospital every day. We have found that this is the most sustainable and effective solution for providing surgery. As an added benefit, as surgeons become experts, they train their colleagues, create local mentoring relationships, and build a global network of people focused on orthopaedic care in low-resource environments.
Cambodia (2018)
Tanzania (2026)
Dr. Zirkle’s initial expansion of SIGN involved hands-on mentorship and education models. While maintaining a private practice, he personally traveled to countries like Vietnam and Indonesia to help surgeons learn how to use the implants he manufactured and donated.
As SIGN expanded and Dr. Zirkle stopped traveling, surgeons were empowered to become educators and leaders in their home countries. The SIGN Model adapted to a model of local experts providing training to their colleagues, creating a sustainable solution to expanding fracture care in areas of need. Today many of our oldest surgeons follow in Dr. Zirkle’s footsteps, by spreading SIGN’s mission to new places and teaching fellow surgeons.
Since 1999, more than 7,000 surgeons have been trained in the SIGN Technique. Empowering surgeons permanently changes the landscape of healthcare in LMICs for the better; increasing the number of patients healed and boosting confidence in local healthcare systems.