Traditional Bone Setters Research Articles

Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters

BackgroundTraditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other low- and middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. The aim of the study was to establish the feasibility of formal training of TBS and subsequent integration into the healthcare system.MethodsTwo focus group discussions were conducted involving five TBS and eight orthopaedic surgeons in Enugu Nigeria. Audio-recordings made during the focus groups were transcribed verbatim and analysed using a thematic analysis method.ResultsFour themes were identified: Training of TBS, their experiences and challenges; perception of traditional bonesetting by orthopaedic surgeons; need for formal training TBS and willingness to offer and accept formal training to improve TBS practice. Participants (TBS group) acquired their skills through informal training by apprenticeship from relatives and family members. They recognized the need to formalize their training and were willing to accept training support from orthopaedists. The orthopaedists recognized that the TBS play a vital role in filling the gap created by shortage of orthopaedic surgeons and are willing to provide training support to them.ConclusionThis study demonstrates the feasibility of providing formal training to TBS by orthopaedic surgeons to improve the quality of services and outcomes of TBS treatment. This is critical for integration of TBS into the primary healthcare system as orthopaedic technicians. Undoubtedly, this will transform the trauma system in Nigeria and other LMICs where TBS are widely patronized.

Pattern of Pediatric Supracondylar Fracture Operated at A Rural Teaching Hospital of Nepal: A Descriptive Cross-sectional Study

Supracondylar fracture of humerus is one of the common pediatric fractures encountered in our daily clinical practice. The purpose of this study is to determine the pattern of supracondylar fracture operated at rural teaching hospital of Jumla, Karnali Nepal. A descriptive cross sectional study was conducted at Jumla, Karnali after Institutional Review Committee approval. Operating room notes from 15 May 2017 to 16 November 2019 were retrieved to gather the following information: patients address, age, sex, side, injury mechanism, displacement, neurovascular injury, concurrent injuries, initial management by traditional bone setters, time between injury and surgery, operative technique. Data analysis was done using Statistical Package for Social Sciences version 20. Left side predominated with 88 (63.7%) and extension type was common in 135 (97.8%). Thirteen (9.4%) patients were initially managed by traditional bonesetters. A total of 138 children underwent operative fixation with mean age of 7.47 years and gender ratio of 2:1 boy to girl. Fall from cliff, ladders and rooftops were the prevailing cause of injury 73 (52.8%). Average time between injury and surgery was 5.2 days. Closed reduction was done in 100 (72.4%) patients whereas open reduction was necessary in 38 (27.5%) patients. Closed extension type pediatric supracondylar fracture was common in this study. Fall from cliff, rooftop and ladder are the major cause of fracture. Delayed presentation and initial management of the fracture by the traditional bonesetters makes supracondylar fracture more challenging in resource limited setting like ours.

Traditional bonesetters in northern Ghana: opportunities for engagement with the formal health sector.

Introductionwe sought to explore the knowledge and practices among traditional bonesetters (TBSs) in the Northern Region of Ghana and to assess opportunities for their engagement with the formal health sector.Methodswe identified 28 TBSs widely distributed in the Northern Region. They were interviewed using qualitative and quantitative methods, regarding their background, training, current practices, opinions regarding orthodox care, and interests in future linkages with the formal health sector.Resultsmost TBSs (67.9%) had no formal education and most (85.7%) learned their skills from older family members. Their treatments included reasonable versions of closed reduction and immobilization, but also use of locally-derived concoctions and spiritual aspects, such as incantations. Only 21.4% regularly referred complications to hospital. Nonetheless, all endorsed advantages to orthodox care, such as X-rays (100%), record keeping (100%), and pain management (85.7%). Almost all (96.4%) expressed an interest in training courses or other engagement with the formal health sector. Topics in which they were interested for training included record keeping (100%), pain management (85.7%), and management of open fractures and complications (82.1%).Conclusionfactors making linkage between TBSs and the formal health sector difficult included low levels of formal education, training through secretive in-family methods, and spiritual and mystical aspects of their practice that might make communications about modern medicine difficult. Nonetheless, most indicated interest in linking with modern care, especially through training courses. Topics they suggested for such courses provide a foundation to build on in future efforts to engage TBSs with the formal health sector.

Prevalence of anterior cruciate ligament injury among amateur footballers in Enugu, South-East Nigeria: The need for injury prevention programs

Background: Anterior cruciate ligament (ACL) injury is debilitating to any footballer. The injury is sustained in different ways during sporting events. There is need for injury prevention programs among the growing population of amateur footballers. Aim: This study was carried out to determine the prevalence of ACL injury among Amateur footballers in Enugu, South-East Nigeria. Methodology: An observational study involving 825 of the registered amateur footballers in Enugu Metropolis. Oral interview and adapted knee pain evaluation form were used to screen for knee injuries and followed by Lachman and Pivot shift test to confirm ACL injury. Results: The mean age of the participants was 22.7 ± 3.1. The prevalence of ACL injury was 3.6% among the study population (8% for females and 3.5% for males), 56.6% among the participants with a history of knee injuries. Nearly 37.3% of the injuries occurred as a result of torsion/twist, which is a noncontact mechanism, 3.3% due to overuse, 13.3% due to contact/person, and 10.0% due to contact/friction. 70.0% of the injuries occurred during a training session, while 30.0% occurred during competition. Furthermore, 50.0% of athletes sought medical attention from traditional bone setters, 6.7% from physiotherapists, 10.0% from medical doctors, while 30.0% had self-medication. Conclusion: The prevalence of ACL injury among amateur footballers in Enugu, South-east Nigeria, falls within that obtained among athletes worldwide, with most of the injuries occurring from noncontact mechanisms during a training session. The prevalence is more in females than males.

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study.

Background. Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization. Objectives. To determine the prevalence, patterns, and factors associated with CAM utilization among SOA. Methods. In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14. Results. Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28‐3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42‐0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14‐0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30‐2.21) and also used in back pain (OR = 1.22; 95%CI: 1.03‐1.46). Conclusions. CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.

Indications and challenges of limb amputation in children; Experience in a tertiary hospital in Enugu Nigeria

Background: Limb amputations in children are generally an uncommon procedure and are usually associated with significant emotional implications for the patients and their caregivers. Apart from emotional issues, this surgical procedure, which is often life-saving is fraught with challenges in a developing country. The aim of the study was to review indications and challenges posed by presentation and consent time in managing children who need amputation. It is hoped that highlighting the challenges will be helpful in improving care for children who may be involved. Patients and Methods: This was a retrospective study of all children 16 years and below who had limb amputation in Enugu State University of Technology Teaching hospital between January 2015 and December 2019. Results: They were 22 amputations involving 13 (59.0%) males and 9 (41.0%) females, giving a ratio of 1.4:1. Amputations of the lower limb occurred in 15 (68.2%) cases, while the upper limb was involved in 7 (31.8%) cases. Road traffic accident (RTA) 6 (27.3%) and sequalae of Traditional bone setter's (TBS) intervention 6 (27.3%) after trauma were the most common indications for amputation. Delayed wound healing was the most common complication seen. No mortality was recorded, and consent for surgery was the most common challenge encountered. None of the patients was able to acquire prosthesis due to financial constraints. Conclusion: RTA and bone setter's intervention in trauma management leading to gangrene are the most common indications for amputation in children. Comprehensive Child health care plan addressing observed challenges could bring a better outcome in children who may need amputation.

A Review of the Current Status of Bamboo Usage with Special Emphasis on Orthopedic Rehabilitation

It was found that bamboo has been extensively used as infrastructure material in Asia and Africa due to its exceptional properties. Its usage has ranged from simple fence construction to bridges. Bamboo, as a biodegradable and renewable material, has been used for construction purposes. Both the natural and engineered form of the Bamboo has become a center of focus for most research scientists, materials experts and most important research and development aspects of Industries. The physical and mechanical properties of Bamboo culm in its dry and green state have shown promising prospects and this has further established the need to put together a regulatory body that will help to monitor and create standards for testing and utilizing Bamboo. This paper considered the various applications of Bamboo culm both in the past and present. An area the authors considered in this paper is the use of Bamboo in orthopedics. The number of people with gait dysfunction is fast growing due to population growth, war, ageing and accidents. The cost of orthopedic devices essential to restore function and improve quality of life is not affordable for many. Earlier research in this area suggests that bamboo is a suitable material for orthopedic appliances, especially exoskeleton. Bamboo use in applications such as orthopedic rehabilitation is common in developing countries where traditional bonesetters (TBS) use splints to treat fracture. In spite of the innovative discovery made by researchers in the use of Bamboo, standardization is a major challenge especially in orthopedic application. The focus of our work revealed varieties of Bamboo application.

A COMPARATIVE QUALITATIVE STUDY OF THE TYPES OF TRADITIONAL TREATMENT OF FRACTURES BY TRADITIONAL HEALTH PRACTITIONERS IN KWAZULU-NATAL, SOUTH AFRICA AND THE NORTH ISLAND OF NEW ZEALAND: A SURVEY-BASED STUDY

Ponte Academic JournalDec 2020, Volume 76, Issue 12 A COMPARATIVE QUALITATIVE STUDY OF THE TYPES OF TRADITIONAL TREATMENT OF FRACTURES BY TRADITIONAL HEALTH PRACTITIONERS IN KWAZULU-NATAL, SOUTH AFRICA AND THE NORTH ISLAND OF NEW ZEALAND: A SURVEY-BASED STUDY Author(s): Nireshnee Ramchundar ,Manimbulu NlootoJ. Ponte - Dec 2020 - Volume 76 - Issue 12 doi: 10.21506/j.ponte.2020.12.12 Abstract:Traditional methods for the treatment of fractures world-wide include the physical manipulation (resetting) of bones and traditional remedies in various dosage forms. Although traditional bone-setting is no longer widely practiced in most developed countries, traditional remedies (plant or animal derived) are still used to treat fractures. Traditional health practitioners administer a variety of herbal medicines for bone strengthening, pain relieving, inflammation reduction and speedy recovery of fractures. The aim of this study was to determine the types of treatment administered for fractures according to Zulu medicine practices in Kwazulu-Natal, South Africa and Māori medicine practices in the North Island of New Zealand. Traditional health practitioners who routinely practice in urban, semi-urban and rural areas of three districts each in Kwazulu-Natal, South Africa and in the North Island of New Zealand were surveyed between October 2018 and September 2019. A mixed method study was conducted by a survey, and a moderator with a single focus group of three traditional health practitioners, resulting in qualitative research based on their practices in the management of fractures and fracture-related injuries. In both South Africa and New Zealand, traditional health practitioners included in this study practiced in a similar way, mainly as Zulu herbalists or Izinyanga in South Africa (22/26, 84.6%) and as Tohunga-Rongoā or traditional Māori practitioners who are experts in medicine and healing (12/12, 100%) in New Zealand. Although the respondents were mainly Zulu herbalists in KwaZulu-Natal, South Africa, four practiced as diviners (Izangoma). Most of the respondents were male practitioners(20/38, 52.6%) who practiced for 11-20 years (13/26, 50%) in South Africa and the same length of time in New Zealand (5/12, 41.7%). It was interesting to note that traditional health practitioners interviewed in this study in both New Zealand and SA, no longer practiced the manipulation of bones or bone-setting. Rather they used traditional herbal mixtures with presumed fracture-healing activity. Traditional health practitioners surveyed in this study identified 47 traditional medicines from South Africa and 27 traditional medicines from New Zealand with presumed fracture-healing activity. The formulae for preparing these traditional medicines were documented. Traditional medicine preparations of Umhlabelo (Talinum caffrum) and Umahlanganisa (Drimia delagoensis) in South Africa, and Harakeke (Phormium tenax) and Tutu (Coriaria arborea) in New Zealand were most prescribed by traditional health practitioners to treat fractures. The use of a support structure for fractures to limit mobility (and prevent further injury) and promote healing by Zulu traditional health practitioners should be encouraged. Further investigation is warranted on the phytochemical compositions of the two most commonly used herbal mixtures identified above, each in South Africa and New Zealand. Download full text:Check if you have access through your login credentials or your institution Username Password

ORTHOPAEDIC EMERGENCY CASES AT HASAN SADIKIN HOSPITAL BANDUNG CAUSED BY TRADITIONAL BONE SETTER PRACTICE

Traditional bone setting is common in developing nations. The practitioners are barely educated and rely so much on experience. Although they are popular in public, traditional bone setter are known in hospital practice for their failures and complications which present to hospitals for remediation.The purpose of the study is to report the orthopaedic emergency cases caused by the practice of traditional bone setter. This was an observational descriptive study, 36 patients with complications after practice of traditional bone setters and subsequently presented to emergency ward in Hasan Sadikin Hospital between 1st January 2015 and 31st August 2017 were evaluated.Among emergecy orthopaedic cases at Hasan Sadikin Hospital caused by bonesetter practice, compartment syndrome and gangrene are the most common complications occured. Twenty patients (56%) with infected wound and compartment syndrome had successful operation., thirteen patients (36%) with gangrene of the extremities had amputations, and three patients (11%) with multiple organ failure died. Twelve percent of amputations in our centre were related to bonesetter practice.The result of this study indicates that traditional bone setters practice may caused patients to develop complications, lose their limbs even lives due to inappropriate treatments.

The Feasibility of a Randomized Controlled Trial for Open Tibial Fractures at a Regional Hospital in Uganda.

The inclusion of low and middle-income country (LMIC) hospitals in multicenter orthopaedic trials expands the pool of eligible patients and improves the external validity of the evidence. Furthermore, promoting studies in LMIC hospitals defines the optimal treatments for low-resource settings, the conditions under which the majority of musculoskeletal injuries are treated. The objective of this study was to determine the feasibility of a randomized controlled trial comparing external fixation with intramedullary (IM) nailing in patients with an isolated open tibial fracture who presented to a regional hospital in Uganda. From July 2016 to July 2017, skeletally mature patients who presented to a Ugandan regional hospital with an isolated Gustilo-Anderson type-II or IIIA open fracture of the tibial shaft were eligible for inclusion. The primary feasibility outcomes were the enrollment rate, the recruitment rate, and the 3 and 12-month follow-up rates. The secondary outcomes included a comparison of 3 and 12-month follow-up rates between the treatment arms and a qualitative assessment of barriers to enrollment, timely treatment, and missed follow-up. During the 12-month enrollment period, 37.5% (30 of 80) of eligible patients were successfully enrolled and operatively treated on the basis of their random allocation, with an enrollment rate of 2.5 patients per month. Of the 30 enrolled patients, 53% completed their 3-month follow-up appointment, and 40% completed their 1-year follow-up appointment. Rates of 1-year follow-up were significantly higher for patients receiving IM nails than for those receiving external fixation (absolute difference, 52%; 95% confidence interval [CI], 21 to 83, p < 0.01). The main reasons that patients declined to participate in the trial were preferences for treatment by traditional bonesetters and prehospital delays that were related to a disorganized referral system. Barriers to follow-up included prohibitive transportation costs and community pressure to turn to traditional forms of treatment. A regional hospital in Uganda can successfully enroll, randomize, and operatively treat multiple patients with an open tibial fracture each month. Patient follow-up presents substantial concerns over trial feasibility in this setting. Cultural pressure to utilize traditional treatments remains a particularly common barrier to study-participant enrollment and retention.

TRADITIONAL BONE SETTING PRACTICE OF RABHA PEOPLE OF ASSAM

Objective: The aim of this work is to document the various ethnomedicinal healing plant species used in traditional bone setting (TBS) practice of Rabha community of Assam.Methods: This has been done using interview method which includes semi-structured questionnaire and the field walks method.Results: The results reveal that eight healing plants wear employed to in the TBS practice. Among these, Cissus quadrangularis L. is the most commonly used plant species to treat bone fracture. In this study, two modes of preparation for the ethnomedicine have been served (i.e., paste and extract) where paste form has higher used (75%).Conclusions: It has been concluded that Rabha Hasong area of Assam is indeed rich in ethnomedicinal plants. People get benefited from the traditional practices performed by the medicine men. This is the chief reason TBS practice that is still running smoothly with full faith and hope even in the current time where sophisticated orthopedic treatments are obtainable. Moreover, systematic nutraceutical appraisal of these species would provide a remarkable research possibility in the fields of ethnopharmacology that would be useful in the modern orthopedic treatments.

TRADITIONAL BONE SETTING PRACTICE OF RABHA PEOPLE OF ASSAM

Objective: The aim of this work is to document the various ethnomedicinal healing plant species used in traditional bone setting (TBS) practice of Rabha community of Assam.Methods: This has been done using interview method which includes semi-structured questionnaire and the field walks method.Results: The results reveal that eight healing plants wear employed to in the TBS practice. Among these, Cissus quadrangularis L. is the most commonly used plant species to treat bone fracture. In this study, two modes of preparation for the ethnomedicine have been served (i.e., paste and extract) where paste form has higher used (75%).Conclusions: It has been concluded that Rabha Hasong area of Assam is indeed rich in ethnomedicinal plants. People get benefited from the traditional practices performed by the medicine men. This is the chief reason TBS practice that is still running smoothly with full faith and hope even in the current time where sophisticated orthopedic treatments are obtainable. Moreover, systematic nutraceutical appraisal of these species would provide a remarkable research possibility in the fields of ethnopharmacology that would be useful in the modern orthopedic treatments.

Assessing the Effect of Training of Traditional Bone Setters in Enugu State South East Nigeria

In Nigeria, the traditional bone setters, perhaps more than any other group of traditional health provider enjoy high patronage and confidence by the society. 5,6 Indeed, the patrons of this service cut across every strata of the society including the educated and the rich. 5-7 The origin of the practice is shrouded in mystery but passed on by practitioners from one generation to another 8-10 . Methods: Bivariate analysis was used with the aid of SPSS Version 16 and Epi-info version 6; respondents were described by their socio-demographic characteristics, a comparison of intervention and control group were checked with the chi-square analysis at base line to determine the differences in their knowledge and practice of Traditional bone setters on traditional bone setting. It was also carried out at post-intervention period (6 months after intervention) to determine the effect of training of traditional bone setters on the uptake of X-ray services, modern orthopedic practices, POP, anti-tetanus injections, antibiotics and insecticide treated nets. Results: The general knowledge of bone setting by the respondents improved after training, except in the need to provide the in-patients with ITNs which recorded no change. After the training, all the traditional bone setters knew the importance of having nurses and other paramedical staff in their clinics (p = 0.000). The signs and symptoms of wound and tetanus infection did not change after training. However, the need for sterilization of instruments and hygienic dressing improved significantly after training (p = 0.000). Equally, the knowledge of the need for POP improved significantly (p = 0.005). Interestingly, the acknowledgement that continual adjustment of splitting could lead to mal-union or non-union improved statistically after training (p = 0.000). The practice of bone setting by TBSs in the study group after training statistically improved. The acceptance of training of other people in the clinics and use of antibiotics/anti-tetanus toxoid were statistically significant after training of the TBS in the study group. Interestingly, the referral of patients with serious fracture to orthopedic surgeons for better management improved significantly after training (p = 0.039). Conclusion: From the study, there were remarkable improvements in the management of bone fracture by TBSs after training. The knowledge, attitudes and practices of TBSs improved significantly after training on basic orthopedic practices. There was also an improvement on prompt referral of serious fractures to orthopedic surgeons for better management. Keywords: ITN; Traditional Bone Setting; TBS; ITN; Orthopaedic surgeons DOI : 10.7176/JHMN/58-08

Open fractures: epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria.

IntroductionManagement of open fractures poses a constant challenge to Orthopaedic surgeons in Nigeria. Our aim is to determine the epidemiological pattern of open fractures in our centre and share our experiences on the initial management and problems encountered.MethodsThis was an 18 month prospective study of patients that presented with open fractures at our emergency room. Already prepared data collection sheets were used to collect relevant data directly from patients and patients' files.ResultsThere were 58 open fractures in 52 patients (31 males and 21 females). Mean age of patients was 36.4 ± 12.2 years. Most patients (82.7%) fell within the age group of 20-49 years. Traders (28.9%) and students (19.6%) were mostly affected. Most open fractures (88.5%) were due to road traffic accidents. The tibia and fibula were the most frequently affected (44.4%). Most injuries were Gustilo et al. types IIIA & IIIB (79.3%) open fractures. Patients had initial resuscitation followed by debridement in 42 cases (72%). Fractures were initially stabilized with external fixators in 23 cases (39.7%) and cast slabs in 19 cases (32.8%). The average time between presentation and debridement was 30 hours and average hospital stay was 36 days. Forty two point five per cent of wounds were infected.ConclusionOpen fractures were mostly due to road traffic accidents and affected the tibia and fibula most frequently with Gustilo et al. types IIIA and IIIB forming the bulk of the injuries. Management was challenging with late presentations, scarcity of resources and consequent high rate of infections, prolonged morbidity and hospital stay. These problems were worsened by delay in antibiotic commencement and initial debridement, sub-optimal treatment at peripherial hospitals and mis-management by traditional bone setters.

Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution

Background: Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation. Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population. Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below-knee amputation (46.8%), followed by above-knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis. Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees.

Study on risk factors affecting nonunion of fractures

INTRODUCTION: Nonunion is one of the most common complications of fracture healing. The incidence of nonunion is believed to vary from 5% to 10%. AIM: The aim of the research is to study the risk factors affecting nonunion of fractures and analyze the treatment taken, and it is bearing on nonunion. MATERIALS AND METHODS: The study is a cross-sectional observational study with purposive sampling done in the orthopedic department. A total of 71 patients were selected, and a questionnaire was filled in with data obtained from the patient and medical records. Radiological evidence was also used to confirm the nonunion. RESULTS: The sample included 48 men and 23 women. Of the females, 21 had attained menopause (91%). About 58% of the patients had taken treatment from Traditional Bone Setters (TBS), and 49% of the patients first went to a TBS before coming to the allopathic physician for fracture treatment. About 45% of the patients had a very short duration of immobilization of their fractures. A history of previous malignancy, bone cyst, or other illnesses lead to a longer time for recovery and return to work (P = 0.0339). Patients who had infected fractures had a significantly more number of surgeries than those without infection (P = 0.015). Nonsteroidal anti-inflammatory drugs use during treatment of fracture was also associated with nonunion (P = 0.0077), especially in allopathic medicine. CONCLUSION: Nonunion continues to be a significant problem for all orthopedic surgeons despite their best ability to prevent them. A complete examination of the patient with relevant investigations and selection of the most suitable and appropriate treatment for each individual should be carried out; since each person is unique, and every fracture is not alike.

Neglected fracture tibia dextra with gangrene pedis, post treatment by traditional bone setter

The patient is a 9-year-old female who comes from Oba District, Tidore island. Come to Emergency Department Ternate General Hospital with the right leg limbs which have blackened, some open wounds on the skin that give exposure to soft and hard tissue (bone). According to the alloanamnesis,, before entering the hospital, she treated for three weeks in traditional bonesetter due to fractures. Given the traditional treatment of herbal concoction cream and in splints with a bamboo stick and the therapy wasn’t successful. Clinical evaluation revealed a gangrenous right leg for which she had the risk of an above knee amputation. The diagnosis was gangrene pedis dextra e.c. neglected fracture tibia dextra post-treatment by the traditional bone setter. Operative management was wound debridement and amputation I-V metatarsal. Neglected fracture is a fracture that is not handled correctly, resulting in delays in handling, worse conditions and even defects. The purpose of writing this case report is to provide an overview of the neglected case of fractures caused by traditional bonesetter.

Characteristics and Outcome of Paediatric Long Bone Fractures Managed in a University Teaching Hospital

Fractures constitute a significant component of paediatric trauma. Paediatric fractures account for significant morbidity. This study was set to elucidate the characteristics and outcome of paediatric fractures in a university teaching hospital. Case notes were reviewed for socio-demographic and clinical variables. Statistical analysis was carried out using the software Statistical Package for Social Sciences for Windows, Version 21.0. The correlation between development of complications and prior treatment by traditional bone setters was determined using chi-squared tests. Fifty four long bone fractures were studied in 52 children. Their ages ranged from 1 day to 16 years with a mean of 8.85 ± 3.86 years. There were 29 males (55.8%) and 23 females (44.2%). The aetiology of childhood fractures included road traffic crashes (n=30, 57.7%), falls (n=10, 19.3%), sports injuries (n=8, 15.4). The long bones fractured were tibia (n=19, 35.2%), femur (n=14, 25.9%), distal radius (n=14, 25.9%) and supracondylar part of the humerus (n=7, 13.0%). Non-operative treatment modalities were the most frequent means employed in treating children with fractures in this study. Limb gangrene following prior treatment by traditional bone setters was the most common complication. There was a statistically significant correlation between development of complications and prior traditional bone setters treatment (p&lt;0.001). Paediatric fractures were more common in boys, caused mostly by road traffic crashes. Most were patients discharged without deformities. Public enlightenment on trauma prevention, enforcement of school bus transport system and reducing street hawking by expanding school feeding programmes may help reduce incidence of paediatric fractures.

Musculoskeletal Tumors of the Extremities: Challenges and Outcome of Management in a Nigeria Tertiary Hospital

Background: Patients with musculoskeletal tumors in developing countries often present late to the hospital and this poses serious challenges to the management, especially for malignant tumors. This study aims to highlight the various types of musculoskeletal extremity tumors seen in a Nigerian tertiary health center during the study period, the challenges encountered in managing them, and the outcome of the management. Materials and Methods: A prospective study in which all consenting patients with musculoskeletal extremity tumors who presented to the center from April 2015 to March 2017 were recruited. Results: Seventy‑two patients were managed during the study period. The mean age was 22.1 ± 4.5 years and the age group most affected was the 11–20 years group, n = 22 (30.6%). Male‑to‑female ratio was 1.6:1. The femur was the most commonly involved bone. Forty tumors were benign while 32 were malignant tumors. Osteochondroma was the most common benign tumor while osteosarcoma was the most common malignant tumor. The challenges encountered during the management were a late presentation, poverty, and traditional bonesetter intervention before the presentation. Patients with benign tumor had excision with good outcome in all. Twenty (62.5%) of the patients with a malignant tumor had the ablative procedure, two of these 20 patients died within 6 months of treatment, while 12 (37.5%) of the patients with malignant tumor refused the treatment. Conclusion: Management of musculoskeletal extremity tumors is highly challenging in this part of the country, especially the malignant types, due to the challenges mentioned. There is a need for more awareness about the disease, the Government should subsidize the cost of management of this disease, and more specialty training of personnel is necessary for appropriate management of the diseases. Keywords: Extremity, musculoskeletal, tumor.

Complications of Fracture Treatment by Traditional Bonesetters in West Java, Indonesia

Background : Traditional medicine practices are still occurring especially in developing countries such as Indonesia. One of the traditional practitioners is the traditional bonesetter (TBS). Due to lack of knowledge of human anatomy, physiology, infection prevention and control, the practices of the TBS has a risk to increase the complications in fractured patients. The objectives of this study was to identify the complications of fractured patients treated by the TBS who were admitted to dr. Hasan Sadikin General Hospital in West Java, Indonesia Methods : This descriptive study involved 86 medical records of fractured patients admitted to the hospital, from January to December 2014. The collected data were gender, age, admission time after occurrence of the fracture, site of the fracture and early or delayed complications. Moreover, those data were analyzed and presented using frequency tabulation. Results : Out of 86 patients; 61 (70.93%) were males; 16 (18.60%) were 21–30 years old; 25 (29.07%) had fractures 1–3 months before admitted to the hospital; 83 (96.51%) had closed fractures. There were 86 patients with 109 fractures location; 66 (76.74%) had fractures in one location; 41 (37.61%) had femoral fractures. Half of the patients had malunion. Conclusions : The most complication is malunion.