From October 1-17, 2023, Dr. Khormaee visited the Surgical Implant Generation Headquarters (SIGN) to serve as a faculty member for their growing spine program.  For the last decade, Dr. Khormaee has been involved with SIGN, an organization based out of her home state of Washington that manufactures orthopedic implants for the injured poor.  

Unlike in the United States, in many low and middle income countries, patients have to purchase their own implants for surgery.  This means that patients who are injured, commonly in traffic and workplace accidents, have to marshal the funds to pay for their implants prior to getting surgery.  Often patients who cannot afford the implants get a surgery that is lower than the standard of care and/or don’t get surgery at all, as these implants are often critical to provide stability to allow injuries to properly heal.

SIGN works to address this need by providing implants at no charge to patients.  This was the idea of the SIGN founder, Dr. Lewis Zirkle, who has had an incredible impact on treating the injured poor around the world through SIGN.   Currently, SIGN focuses on fractures of the long bones in the arms and legs (the humerus, femur), and every day, approximately 150 surgeries using SIGN implants are done worldwide.  In exchange for providing these implants, SIGN asks surgeons and patients to provide clinical outcomes on their surgeries, and in doing so, has created a dynamic, skilled community of surgeons in 57 countries focused on providing the best care possible for patients.   Every year, SIGN holds a conference where orthopedic surgeons around the world are invited to attend and exchange ideas, as well as learn new skills. 

Dr. Khormaee is involved in SIGN as it expands to helping patients with spine injuries.  Like for other orthopedic injuries, spine patients who are in low resource regions often have to purchase their own implants for surgery. She experienced this firsthand when she visited Myanmar and worked with orthopedic surgeons there during her residency in 2017.   There, she met one of her research lab members, Dr. Myat Thu Win,  who at the time was a spine fellow.  He and his mentor, Professor Aung Thein Htay, took her to market where screws and rods are purchased for spine surgery.  This is similar in many countries where patients have to purchase their own implants for surgery and in Myanmar, like other countries, many patients find the cost of implants too high to get necessary surgery.

SIGN is working to address this critical patient need by following the model pioneered by their other fracture program.  By combining education of surgeons and access to implants, the goal is to expand access to spine care by skilled surgeons with the tools and implants patients need.  Dr. Khormaee helped in this mission during her visit to the annual SIGN conference in October 2023, where she taught other spine surgeons surgical techniques.  In collaboration with SIGN and nonprofit Enuval, she is using her engineering background to investigate high quality, low cost solutions for spine implants.  She was fortunate to spend time with Dr. Zirkle who is an enormous inspiration and thought leader to understand more about how the SIGN team functions to scale its impact globally.

One of her SIGN colleagues, Dr. Mandeep Parthak, an orthopedic surgeon and SIGN surgeon who practices at Bayalpata Hospital in Nepal will be holding a conference on rural orthopedic surgery at his hospital, and Dr. Khormaee is an invited faculty member for this event in Spring 2024.   In Dr. Parthak’s hospital, some of the most common spine injuries occur when women who climb trees to cut off foliage for livestock fall from the trees and get spine fractures.  Unfortunately, there is no trained spine surgeon at Dr. Parthak’s hospital, the nearest referral hospital is sometimes inaccessible during certain seasons because of weather and there are no spine implants/tools at his hospital.  Thus, many of these patients don’t get the care they need.  The goal during the conference is to look into ways that these problems might be addressed.    

To read more about the SIGN Spine Day 2023, click here.  For further interest in this topic, please reach out by sending an email to skoffice@hss.edu.