Our mission

IGOT's mission is to build capacity in musculoskeletal care through global partnerships.

Our team

• Theodore Miclau, MD

Director of OTI

• David Shearer, MD, MPH

Director of Research, IGOT

• Richard Coughlin, MD, MSc

Director, IGOT

• Dr. Saam Morshed, MD, PhD, MPH

Director of Research, IGOT

• Madeline MacKechnie, MA

Global Surgical Education Program Coordinator, IGOT

• Nae Won, MPH

Operations Coordinator, IGOT

Our work

Education
• IGOT's Education initiative strives to provide orthopaedic surgeons from low-and-middle income countries (LMICs) with the training and educational resources needed to save limbs and lives. To prevent amputations in LMICs, IGOT has created the Surgical Management and Reconstructive Training (SMART) Course, which is hosted annually in San Francisco, as well as, internationally in Tanzania, Nepal, and Guadalajara.
• IGOT's Learning Portal goal is to offer an online platform for surgical education that is easily accessible, self-paced, and free to supplement the content of the SMART Course, as well as, provide access to those who are unable to attend a course. The IGOT Portal is a novel endeavor that we hope to scale and expand using already existing technology. It strives to leverage our expert network of faculty and partner institutions to crowdsource solutions to surgical cases and meet the needs of orthopaedic surgeons in developing countries.
• The purpose of IGOT's Global Rotation Elective and Global Scholars Program and Orthopaedic Observership is to facilitate the flow of orthopaedic knowledge between our global partners and UCSF's Department of Orthopaedic Surgery. We invite members of our partner institutions to partake in the Global Scholars Program and Orthopaedic Observerships at the Orthopaedic Trauma Institute (OTI) to share knowledge of various surgical methods in the U.S. healthcare system. IGOT also enables fourth-year UCSF orthopaedic residents to learn from our global partner sites through a one-month Global Elective Rotation abroad.

Research
• The IGOT Global Research Initiative (GRI) seeks to improve research capacity in low- and middle-income countries through academic partnership. Led by David Shearer, MD, MPH and Saam Morshed, MD, MPH, PhD, the GRI is among the leading centers in the country actively conducting prospective research in the field of orthopaedic surgery in low-resource settings. Our principal partners include academic centers in Tanzania, Malawi, Uganda, and Latin America.

Leadership
• The Consortium of Orthopaedic Academic Traumatologists (COACT) promotes global health efforts in musculoskeletal trauma care through the sharing of best practices, research opportunities, mentorship and resources. COACT has over 30 member institutions, representing leading Orthopaedic Departments at major Universities throughout North America. COACT fosters the development of collaborative networks through regular communication, face-to-face meetings and an online interactive database.
• The Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR) is an international initiative that aims to increase capacity for orthopaedic research in Latin America. This novel group serves as a network for surgeon-leaders across the Americas interested in conducting clinical research to ultimately improve trauma-related skeletal injury treatment in broad patient populations across Low-to-Upper-Middle Income Countries.

Our projects

           TANZANIA- Intramedullary Nailing Versus External Fixation for Open Tibia Fractures Randomized Controlled Trial

• Open tibia fractures are among the most common and debilitating injuries faced in low-income countries due to high rates of infection and nonunion. This study aims to address the question of whether internal or external fixation is better as definitive treatment for open tibia fractures in Tanzania. The study has enrolled and randomized 240 patients and achieved greater than 90% 1 year follow up. The study is currently conducting final data analysis, and we anticipate publication in the near future.

           TANZANIA- Cost-effectiveness of Prosthetics for Above Knee Amputees

• Many amputees in low-income countries do not receive a prosthesis due to the high cost and failure of most governments to fund prosthetic programs. As a result, they suffer from severe disability and are limited to use of crutches or a wheelchair in most cases. In collaboration with Legworks, a local prosthetics company (www.Legworks.com), IGOT is conducting a prospective study to assess the cost and benefit of a prosthesis for above knee amputees. We believe these data will create a compelling case to advocate for better access to prosthetics in low-resource settings like Tanzania.

           TANZANIA - Low-cost Intramedullary K-wires for Pediatric Femur Fractures

• Femoral shaft fractures in children are commonly treated with surgery using flexible nails to avoid damage to growth plates. However, titanium flexible nails that are commonly used in high-income countries are cost-prohibitive for many families in low-income countries where governments to not subsidize implant cost. Substituting titanium flexible nails with stainless steel “Kirschner wires” could reduce the cost of these implants nearly 40-fold, thereby markedly increasing access to surgery for children globally. IGOT is supporting a randomized controlled trial in Tanzania comparing these low-cost implants to the high-cost titanium nails for children with femoral shaft fractures.

           MALAWI- Intramedullary Nailing Versus Skeletal Traction for Femoral Shaft Fractures

• IGOT Is working in collaboration with investigators at Beit CURE Hospital in Blantyre, Malawi to conduct a prospective multicenter study comparing quality of life and cost-effectiveness of surgery versus skeletal traction for adult femoral shaft fractures. The study has enrolled more than 200 patients and achieved a follow up rate at 1 year of nearly 90%, which is unprecedented. The study is anticipated to complete final follow up in the Summer of 2019. This will be the largest and most rigorous study comparing surgical and non-operative treatment for femoral shaft fractures ever conducted.

           UGANDA- Post Injection Risk and Gluteal Fibrosis Study

• Dr. Coleen Sabatini, leader of IGOT’s pediatric outreach efforts, has developed a robust partnership in Uganda exploring the surgical outcomes of children treated for gluteal fibrosis, along with a qualitative study on injection practices. The qualitative study on injection practices currently has 60 interviews completed and submitted an article to be published. A third study is also being conducted regarding treatment of intra-articular and extra- articular distal femoral fractures using SIGN nail at Kumi Orthopaedic Center. This study has completed data collection and analysis and found 48% f/u at 16 weeks.

           LATIN AMERICA- ACTUAR Open Tibia Study

• Dr. Theodore Miclau, MD, Vice Chairman and Director of Orthopaedic Trauma of the Department of Orthopaedic Surgery at UCSF, fostered our international partnerships in Latin America. There is need for global North American-South American relationships that allow South American colleagues to access resources available in North American centers, which include expertise, organization, and infrastructure, to address research questions relevant to the South American countries. To this end, the Asociación de Cirujanos Traumatológicos en las Americas (ACTUAR) was developed. ACTUAR, led by organizing faculty from UCSF/IGOT, is the product of a group of orthopaedic surgeons interested in an international collaborative initiative focused on building research capacity across institutions throughout Latin America. The consortium is currently in the process of planning a prospective multicenter study to examine the state of care and predictors of quality of life after open tibial shaft fractures in Latin America.