Sign Fracture Care International

The concept for SIGN evolved more than 40 years ago when the founder and president of SIGN, Lewis G. Zirkle, MD, was serving as an army orthopaedic surgeon in Vietnam. In addition to treating military personnel, he treated the crippling injuries of Vietnamese civilians and developed a compassionate concern for their health needs.

Working with like-minded surgeons, engineers and concerned citizens, Dr. Zirkle laid the groundwork for a comprehensive model of building orthopaedic capacity overseas by combining implants and instruments, and training that would equip surgeons in developing countries to treat trauma victims. The vision became a reality in January 1999 when SIGN Fracture Care International was officially incorporated as a nonprofit corporation in the State of Washington.

In May 1999, Dr. Zirkle traveled to Southeast Asia to initiate SIGN’s first “pilot projects” in public hospitals – one each in Thailand and Indonesia, and two in Vietnam. He assisted in surgeries to train local surgeons in SIGN techniques. SIGN donated the implants and corresponding instruments for each project. These pilot projects became the template for partnerships with local surgeons in other parts of the world. The local surgeons immediately saw the value of the SIGN IM Nail System and became proficient at the surgical technique. The message of SIGN quickly spread throughout Vietnam and into other SE Asia countries where road traffic accidents were already at epidemic levels.

SIGN staff provides support of the daily communications amongst SIGN surgeons from more than 50 countries who use SIGN products and training to heal their patients. These surgeons have partnered with SIGN to treat more than 100,000 patients since 1999. SIGN is known and respected throughout the orthopaedic world for its effective teaching model and innovative implants.



We build orthopaedic capacity in developing countries by collaborating with the local surgeons to develop training and implants that support their efforts to provide effective orthopaedic surgery to the poor. We design and manufacture surgical implants and instruments that we donate, or provide on a cost reimbursement basis, to under-resourced hospitals for the surgeons’ use. We coordinate orthopaedic training of the surgeons in the use of our equipment and other orthopaedic procedures. With our help, surgeons can treat more patients and hasten healing so patients can return to work and resume care and feeding of their families.