Abstract
BACKGROUND: In the Lake Atitlán region of Guatemala, traditional bonesetters (hueseros) commonly treat bone fractures. The indigenous Kaqchikel population has access to biomedical care, but traditional medicine remains the preferred treatment modality for bone fracture.
 
 METHODS: Households in four villages were surveyed to assess experiences with bone fracture treatment. Of 108 households sampled, 83 met inclusion criteria and completed the survey. Responses were analyzed to assess for group demographics, bone fracture prevalence, and treatment history. Independence testing assessed for subgroup differences.
 
 RESULTS: Mean age: 40 years old. For fracture treatment, 37% (31/83) consulted with a physician/nurse whereas 75% (62/83) consulted with a bonesetter. 19% (16/83) consulted with both. Cast immobilization was utilized by only 16% (13/83) of participants. The services provided by bonesetters included massage, temazcal (sweat lodge), herbal poultice, prayer, and recommended rest. When comparing participants that used a cast (n=13) and those that used a bonesetter exclusively (n=46), the bonesetter group had lower rates of continued pain and movement limitation, higher satisfaction with treatment, and higher interest in seeking the same treatment in the future, though these findings were not statistically significant. Regarding future care, 66% (55/83) would consider consulting a doctor whereas 83% (69/83) would seek services from a bonesetter. 53% (44/83) would utilize both.  If recommended, 46% (38/83) would consider using a cast. Only 22% (18/83) of participants reported previous musculoskeletal imaging.
 
 CONCLUSION: These results suggest a high preference of bonesetters for bone injury treatment, reduced acceptance of biomedical care, and limited acceptance of cast immobilization.
Highlights
There were nearly 140 million new bone fractures worldwide in 2017 according to the most recent Global Burden of Disease study (James et al, 2018)
The services provided by bonesetters included massage, temazcal, herbal poultice, prayer, and recommended rest
22% (18/83) of participants reported previous musculoskeletal imaging. These results suggest a high preference of bonesetters for bone injury treatment, reduced acceptance of biomedical care, and limited acceptance of cast immobilization
Summary
There were nearly 140 million new bone fractures worldwide in 2017 according to the most recent Global Burden of Disease study (James et al, 2018). Fractures are commonly due to falls and falls are the 18th leading cause of disability-adjusted life years (Kyu et al, 2018). Like falls, leading to bone fractures can be devastating to residents of lower-income countries, like Guatemala. Guatemala is home to 17.9 million people with a median age of 19.4 years. The United States is home to over 322 million people with a median age of 37.4 years (GHO, n.d.; WHO, n.d.; United Nations, n.d.). According to the most recent 2018 Guatemalan census, there are 22 different Mayan languages across the country with 42-66% of the population identifying as indigenous Mayan (Montenegro & Stephens, 2006; Portal de Resultados Del Censo, 2018). In the Lake Atitlán region of Guatemala, traditional bonesetters (hueseros) commonly treat bone fractures. The indigenous Kaqchikel population has access to biomedical care, but traditional medicine remains the preferred treatment modality for bone fracture
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