Richard F. Kyle, MD, presented Lewis G. Zirkle Jr., MD, with the Humanitarian Award during the 2007 AAOS Annual Meeting in San Diego.


Published 3/1/2007
Carolyn Rogers

‘One AAOS surgeon can change the world’

AAOS honors Lewis G. Zirkle Jr., MD—an ‘ultimate humanitarian’—with the 2007 Humanitarian Award

On Feb. 15, the Academy bestowed its 2007 Humanitarian Award on Lewis G. Zirkle Jr., MD, in recognition of his lifetime of commitment to alleviating musculoskeletal suffering worldwide. Accompanying the award was a $5,000 donation to the Surgical Implant Generation Network (SIGN)—a humanitarian organization founded by Dr. Zirkle, which is dedicated to creating equality of fracture care throughout the world.

“Dr. Zirkle’s work dramatically alleviates human suffering by restoring health to individuals with disabling fractures,” said Richard F. Kyle, MD, 2006-2007 AAOS president, as he presented the award. “Today we honor an ultimate humanitarian.”

Overwhelming support
Given his extraordinary accomplishments, it isn’t surprising that the Academy was inundated with glowing letters of commendation and support for Dr. Zirkle when the call went out for the 2007 AAOS Humanitarian Award nominations.

“Dr. Zirkle is living evidence that one AAOS surgeon can change the world,” wrote Stephen S. Tower, MD, one of dozens of colleagues and supporters who voiced their admiration and respect for Dr. Zirkle.

Vision: Equality of fracture care throughout the world
Until recently, treatment with intramedullary (IM) nails—the state-of-the-art method for treating many serious fractures—has not been available to the poor in developing countries. “One of SIGN’s goals is to make this the worldwide standard for fracture treatment,” Dr. Zirkle says.

SIGN was officially incorporated in 1999, but its mission began back in 1968, when Dr. Zirkle served as an Army orthopaedic surgeon in Vietnam. The suffering he saw among the Vietnamese people led him to spend much of his spare time treating Vietnamese civilians.

At the end of his tour, Dr. Zirkle returned to the United States and established a practice. Yet the troubles of people like those he’d met in rural Vietnam, whom he has called “the gray people”—people ignored by others—were never far from his mind. Over the next three decades, Dr. Zirkle made repeated trips to Vietnam and other developing nations to assist local doctors in devising more effective surgical techniques for treating fractures.

In the 1980s, his compassion led him to Indonesia, which at the time had just one orthopaedic surgeon for its entire population of 80 million. There, he trained more than 50 orthopaedic surgeons and established four teaching centers.

Richard F. Kyle, MD, presented Lewis G. Zirkle Jr., MD, with the Humanitarian Award during the 2007 AAOS Annual Meeting in San Diego.
In Honduras, Lewis G. Zirkle Jr., MD, (right) sits beside 15-year-old Elver—the breadwinner for his entire family—who was able to return to normal life after being treated with a SIGN implant.

On his return to Indonesia some years later, however, Dr. Zirkle and his Orthopaedics Overseas colleagues were shocked to find a man who had spent three years in traction, wasting away in a hospital room.

“Speaking with this man was a sentinel event,” he says. “It inspired us to change our priorities.”

Although the doctors in Indonesia were skilled and eager to learn new techniques, they didn’t have the implants they needed to fix the fractures. The need for ongoing education, communication, and a reliable supply of implants and other surgical materials was evident.

Awe-inspiring results
Dr. Zirkle soon laid the groundwork for SIGN—an all-encompassing system of training, hardware, follow-up, and repeat visits to surgeons in developing countries. In May 1999, he traveled to Southeast Asia to initiate four SIGN pilot projects in public hospitals.

Today, the SIGN network has more than 130 projects in 43 countries, and is growing by 25 percent a year. SIGN-trained surgeons have performed more than 20,000 operations.

“After being trained in the system at one SIGN project, doctors are inspired to establish SIGN projects at their own hospitals,” Dr. Zirkle explains. “It keeps expanding from there.”

How does it work?
SIGN IM-nails, screws, jigs, and other necessary hardware are produced in the organization’s state-of-the-art manufacturing facility in Richland, Wash. The implantation instruments and about 100 nails are donated to each new SIGN project at a cost of about $15,000. Once the nails are used, new nails and screws are supplied to each SIGN site free of charge.

“Although Dr. Zirkle gratefully accepts philanthropic donations to help offset the substantial costs of labor and manufacturing, he bears the majority of this huge and ongoing financial outlay,” says orthopaedic surgeon John R. Perry, MD. “Luckily for the nearly 1,000 SIGN trained surgeons, Dr. Zirkle views this as a privilege and his responsibility rather than a burden.”

This work is both a calling and a passion for Dr. Zirkle. “I think it’s so unfair for someone to get their allotted time on this Earth and not be able to enjoy it,” he says. “I’m tremendously lucky, and I believe I should pass some of that enjoyment to others.”

To learn more about SIGN’s mission, visit or contact Dr. Zirkle at