Long bone fracture care in developing countries remains largely different from that of the developed world where closed reduction and internal fixation with locked intramedullary nail is the standard treatment. This study in a developing country presents the pattern and outcome of treatment of 370 long bone fractures using the SIGN nail over a five-year period in order to underline the wide array of patients and fractures treatable with the nail. Using a prospective descriptive approach, all the 342 patients with 370 fractures of the humerus, femur and tibia treated from July 2014 to June 2019 were studied. The fractures were reduced without image intensifier or fracture table and fixed with the SIGN nail. Post-discharge, the patients were followed up at the out-patient clinic. The mean age of the patients was 43.45 years with a range of 10-99 years. Sixty-six percent were males who were mostly injured in motorcycle accidents. Femur, tibia and humerus fractures accounted for 59.7%, 28.4% and 11.9% respectively. Eighty-six percent were diaphyseal fractures, 73% were fresh and the main previous treatment was traditional bone setting. Deep infection occurred in 4.9%, 66.0% achieved knee flexion > 90° by sixth week, the majority achieved full weight bearing and could squat and smile by 12th week. The SIGN nail is versatile, useful for treating a wide range of fractures in most age groups particularly in developing countries where orthopaedic fractures are prevalent but the more sophisticated facilities are lacking or poorly maintained.