Clinical Research at the Institute for Global Orthopaedics and Traumatology


Our work

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.  For inquires, contact: David Shearer (david.shearer@ucsf.edu)

Current projects

IGOT global research sites include:

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.

Recent Publications

1: Eliezer EN, Haonga BT, Morshed S, Shearer DW. Predictors of Reoperation for Adult Femoral Shaft Fractures Managed Operatively in a Sub-Saharan Country. J Bone Joint Surg Am. 2017 Mar 1;99(5):388-395. doi: 10.2106/JBJS.16.00087. PubMed  PMID: 28244909.


2: Kramer EJ, Shearer DW, Marseille E, Haonga B, Ngahyoma J, Eliezer E, Morshed S. The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania. World J Surg. 2016 Sep;40(9):2098-108. doi: 10.1007/s00268-016-3496-z. PubMed PMID: 26983603.

3: Kramer EJ, Shearer D, Morshed S. The use of traction for treating femoral shaft fractures in low- and middle-income countries: a systematic review. Int Orthop. 2016 May;40(5):875-83. doi: 10.1007/s00264-015-3081-3. Epub 2016 Jan 7. Review. PubMed PMID: 26744164.

4: Wu HH, Liu M, Patel KR, Turner W, Baltus L, Caldwell AM, Hahn JC, Coughlin RR, Morshed S, Miclau T, Shearer DW. Impact of academic collaboration and quality of  clinical orthopaedic research conducted in low- and middle-income countries. SICOT J. 2017;3:6. doi: 10.1051/sicotj/2016042. Epub 2017 Jan 30. PubMed PMID: 28134090; PubMed Central PMCID: PMC5278648.

5: Mustafa Diab M, Wu HH, Eliezer E, Haonga B, Morshed S, Shearer DW. The impact  of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study. Injury. 2018 Feb;49(2):323-327. doi: 10.1016/j.injury.2017.11.020. Epub 2017 Nov 16. PubMed PMID: 29162265.

6: Ibrahim JM, Conway D, Haonga BT, Eliezer EN, Morshed S, Shearer DW. Predictors of lower health-related quality of life after operative repair of diaphyseal femur fractures in a low-resource setting. Injury. 2018 May 23. pii: S0020-1383(18)30260-2. doi: 10.1016/j.injury.2018.05.021. [Epub ahead of print] PubMed PMID: 29866624.

7: Mustafa Diab M, Shearer DW, Kahn JG, Wu HH, Lau B, Morshed S, Chokotho L. The  Cost of Intramedullary Nailing Versus Skeletal Traction for Treatment of Femoral  Shaft Fractures in Malawi: A Prospective Economic Analysis. World J Surg. 2018 Aug 9. doi: 10.1007/s00268-018-4750-3. [Epub ahead of print] PubMed PMID: 30094638.

8: Ibrahim J, Liu M, Yusi K, Haonga B, Eliezer E, Shearer DW, Morshed S. Conducting a Randomized Controlled Trial in Tanzania: Institute for Global Orthopaedics and Traumatology and the Muhimbili Orthopaedic Institute. J Orthop Trauma. 2018 Oct;32 Suppl 7:S47-S51. doi: 10.1097/BOT.0000000000001294. PubMed PMID: 30247401.

9:  Miclau T, Hoogervorst P, Shearer DW, El Naga AN, Working ZM, Martin C, Pesántez R, Hüttl T, Kojima KE, Schütz M; International Orthopaedic Trauma Study  Consortium. Current Status of Musculoskeletal Trauma Care Systems Worldwide. J Orthop Trauma. 2018 Oct;32 Suppl 7:S64-S70. doi: 10.1097/BOT.0000000000001301. PubMed PMID: 30247404.

10: Lau BC, Wu HH, Mustafa M, Ibrahim J, Conway D, Agarwal-Harding K, Shearer DW,  Chokotho L. Developing Research to Change Policy: Design of a Multicenter Cost-Effectiveness Analysis Comparing Intramedullary Nailing to Skeletal Traction in Malawi. J Orthop Trauma. 2018 Oct;32 Suppl 7:S52-S57. doi: 10.1097/BOT.0000000000001299. PubMed PMID: 30247402.