Traditional Bone Setters Research Articles

Peadiatric amputation from traditional bone setters’ gangrene in Ibadan: a malady

Background: Pediatric amputations resulting from gangrene pose a significant medical challenge, especially in resource-limited settings. In Nigeria, traditional bone setters (TBS) often serve as the first point of contact for musculoskeletal injuries, but their practices can lead to severe complications, including gangrene. Our hospital manages many of such cases. This study aims to explore the epidemiology, clinical presentation, and outcomes of pediatric patients who developed gangrene requiring amputation following TBS treatment, with the goal of informing public health strategies and improving pediatric care quality. Methods: The study is a retrospective study which seek to extract the data from the hospital record all the patient who underwent amputation due to gangrene after initial TBS treatment. All the case notes were retrieved and data was extracted and analyzed using descriptive statistics. The study adhered to ethical standards and anonymized data to protect patient confidentiality, ensuring the study's integrity. Results: The study involved 33 pediatric patients aged 8.3 years, with a significant gender disparity. Most patients were from the Yoruba ethnic group and practiced Islam. 87.9% of parents had no formal education. Gangrene was most common in the left hand, and falls were the leading cause of initial injury. The average surgery time was 81.2 minutes, with a 13-day hospital stay. Post-operative complications occurred in 43.5% of patients, with surgical site infections (SSI) being the most common. Only 8.7% received occupational therapy. Conclusions: The study highlights post-operative care challenges in pediatric amputations, including high complications and limited access to services. It suggests targeted interventions, infection control, and public health campaigns to improve outcomes. Future research should include long-term follow-up studies.

Predictors of quality of life, economic impact, and loss to follow-up after open tibial shaft fractures in Ghana.

Open tibia fractures are associated with substantial morbidity and impact on quality of life. Despite increasing incidence in low-resource settings, most open tibia fracture research comes from high-resource settings. This study aimed to assess the impact of socioeconomic status on treatment modality and evaluate predictors of health-related quality of life following open tibia fractures in Ghana. A single-center prospective observational study was conducted in Kumasi, Ghana, from May 2020 to April 2022. Adults with open tibial shaft fractures presenting within 2 weeks of injury were eligible. Demographics, comorbidities, socioeconomic factors, and hospital course were collected at enrollment. Follow-up was scheduled at 8, 12, 26, and 52 weeks. A telephone survey assessing reasons for loss to follow-up was initiated on enrollment completion. A total of 180 patients were enrolled. Most patients were employed before injury (79.9%), had government insurance (67.2%), and were from rural areas (59.4%). Fracture classification was primarily Gustilo-Anderson type 3A (49.1%). No relationship between socioeconomic predictors and treatment modality was identified. The largest barriers to follow-up were preference for bonesetter treatment (63.1%), treatment cost (48.8%), and travel cost (29.8%). Of the lost to follow-up patients contacted, 67 (79.8%) reported receiving traditional bonesetter care. Reasons for seeking traditional bonesetter care included ease of access (83.6%), lower cost (77.6%), and familial influence (50.7%). No association was identified between socioeconomic predictors and choice of treatment. Bonesetter treatment plays a substantial role in the care of open tibia fractures in Ghana, largely because of ease of access and lower cost.

Analysis of the Influence of Traditional Bone Setting and Loosening Manipulation of Traditional Chinese Medicine on Sports Rehabilitation after Ankle Operation

To explore the clinical effect of traditional Chinese osteosetting and loosening manipulation after ankle surgery and its influence on rehabilitation. Methods: From September 2022 to March 2023, 70 patients with ankle joint injuries admitted to Longzihu Campus Branch of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected, all of whom received surgical treatment. They were divided into the research group and the control group according to the digital double-blind grouping method, with 35 patients in each group. After the operation, traditional bone setting relaxation and conventional rehabilitation therapy were adopted respectively. The effects of rehabilitation therapy, clinical symptom scores and quality of life of the two groups were compared. Results: The excellent and good rate of the study group was 94.29%, which was significantly higher than that of the control group (77.14%); After treatment, the clinical symptom score of the control group was higher than that of the study group, and the quality of life score was lower than that of the study group (P<0.05), which was statistically significant. Conclusion: The application of traditional Chinese medicine bone setting relaxation method in the postoperative rehabilitation treatment of patients with ankle joint injury can improve the treatment effect, improve the ankle joint function of patients, and accelerate the recovery of patients, which is worthy of promotion.

Prevalence of unintentional injuries and its risk factors among under-five children residing in urban poor resettlements in Rishikesh.

A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries to undertake appropriate preventive measures. Therefore, the current study was conducted in urban poor resettlements of Rishikesh to estimate the prevalence of unintentional injuries and to document the sociodemographic risk factors associated with unintentional injuries among under-five children. Estimation of the prevalence of unintentional injuries and their risk factors among under-five children of urban poor resettlements in Rishikesh. A community-based cross-sectional study was conducted in urban poor resettlement areas of Rishikesh for a period of 1 year. It included 300 children selected using a simple random sampling technique to collect data on injury status. The prevalence of unintentional injury among study participants was 16%. Falls were (64.6%) the major cause of injury, followed by dog bites (12.5%). The major sites of the injury were the head (25%), face (22.9%), upper limb (27.1%), and lower limb (18.8%).75% of the injuries happened at home. 66% of injuries happened when the child was playing alone or playing with peers. About 20.8% of injuries were bruises or superficial injuries. 39.6% of children had cut/bite/open wound injuries. Fractures happened in 14.6% of injured children. More than half (54.2%) of children did not develop any physical disability due to injury. Among children who developed a disability, more than 90% are able to recover completely. The majority of study participants were taken to nearby hospitals (66.6%) or health centers (10.4%). Only one of them went to a traditional bone setter, rest all visited either a general practitioner or pharmacy. The median expenditure for the treatment of the injured child was INR 425 (175-2750). The age of the child and unintentional injury showed a statistically significant association. The prevalence of the injury was 16% (12-20.7%) similar to a number of similar studies. Although the majority of the injuries were mild in severity, injuries have also contributed to temporary disability among children and have led to loss of school days.

Assessing knowledge of hypertension and diabetes mellitus among informal healthcare providers in urban slums in southeastern Nigeria

Informal healthcare providers (IHPs) often serve as the first point of contact for healthcare services for non-communicable diseases in urban slums and their ability to identify risk factors and symptoms of the diseases is crucial for early detection and management. This paper assesses level of knowledge of hypertension and diabetes mellitus (DM) among IHPs. A cross-sectional survey was conducted in eight slums in Enugu and Onitsha cities in south-eastern Nigeria. Data was collected from 238 IHPs including patent medicine vendors, traditional birth attendants, traditional bonesetters, and herbalists. Knowledge scores were computed for each respondent. Adequate knowledge was set at ≥ 50% score and inadequate knowledge at < 50%. Binary logistic regression analysis was used to identify factors/independent variables associated with adequate knowledge among IHPs. Independent variables in the regression model were seven items that describe the profile of IHPs and can influence their access to information on non-communicable diseases. Knowledge of risk factors and symptoms of hypertension and DM among IHPs was low since only 21 (8.82%) and 19 (7.98%) of them had adequate knowledge of hypertension and DM, respectively. In regression analysis, IHPs who had received formal training in the past demonstrated significantly higher levels of knowledge, with odds of adequate knowledge in hypertension being 14.62 times greater for trained providers, and the odds of adequate knowledge of both non-communicable diseases being 21.34 times greater for trained providers. Training of IHPs is needed to address the critical knowledge deficit of risk factors and symptoms of hypertension and DM. This would contribute to better health outcomes and reduced disease burden in urban slums.

Motives and consequences of musculoskeletal injuries management at traditional bone setting centers rather than hospital orthopedic departments in Khartoum, Sudan 2020

Motives and consequences of musculoskeletal injuries management at traditional bone setting centers rather than hospital orthopedic departments in Khartoum, Sudan 2020

TRADITIONAL MEDICINAL PRACTICES OF AFRICAN BONE-SETTERS: ASPECTS OF AN ONTOLOGY OF THE FIELD

Traditional bone-setters (TBS) in West Africa remain the first resort in managing rural populations when they suffer from traumatic injuries before going to hospital. This phenomenon is also observed in urban areas. Indeed, some patients hospitalized in referencial public orthopedic trauma services desert these structures for certain reasons in favor of these traditional healers. This leads us to acknowledge that this local medical practice proves itself where the so-called conventional medicine has shown its limits. Unfortunately, we notice that most of these practitioners are old and illiterate. In addition, there is a lack of interest among the younger generation in practicing this traditional medicine. Also, it is observed that there is no standard or adequate formalism during the patient care process directed towards this medicine. In the effort to preserve this valuable knowledge, we propose to implement an ontology derived from this environment called ontoFRACTURECARE. This ontology is capable of structuring, highlighting, and providing a unique and consensus designation to relevant concepts associated with this domain. Furthermore, this ontology will serve as a compass for bone-setters and various users of this domain for intelligent decision-making during the process of administering care to patients, during the training of practitioners, and in the transmission of this traditional medicinal heritage.

Care seeking behavior of the victims of unintentional injuries: A community-based study in a community development block of Purba Bardhaman District, West Bengal.

Care-seeking after injury episodes is generally associated with major uncertainties concerning its incidence, care, and cure/disappearance, and the price of care. Though the utilization pattern of the population is shaped by social, economic, cultural and political factors, it varies widely for the rich and the poor. With this background, a community-based epidemiological study was conducted to determine the care-seeking behavior of victims of unintentional injuries. A cross-sectional study was conducted from May 2023-September 2023 in the Bhatar block of Purba Bardhaman district, West Bengal. Cluster random sampling was applied to select a required sample of 555 individuals from 24 villages. Study tools used were predesigned and pretested schedules developed by the researchers with the help of guidelines for conducting community surveys on injuries provided by the World Health Organization (WHO). The study had approval from the Institutional Ethics Committee. Descriptive statistics were performed using SPSS V16. Out of 49 injury episodes, 51.0% had received first aid. Out of 39 injury episodes seeking medical attention, a traditional practitioner, healer or bone setter was the type of first medical contact in the case of the majority of injury episodes (38.5%), followed by a hospital (35.9%). Low utilization of government healthcare facilities is a cause for concern. Reliance on unqualified informal healthcare providers is also a cause for concern. Our findings will help design community interventions to increase the provision of appropriate first aid in unintentional injuries.

“Problems you can live with” versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery

Background98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models.MethodsOur study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman’s explanatory models framework and decided to use this to guide the final stages of analysis.ResultsWe found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care.ConclusionsWe found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.

An ethno-botanical survey of medicinal plants used in the treatment of fracture and dislocation in Ogugu, Kogi State Nigeria

The documented information on traditional medicinal plants in Ogugu communities of Kogi State is vague and limited to its species and thus very little research has been done on these medicinal plants. An Ethno-botanical study was conducted to take inventory of the species by the inhabitants of various communities in Ogugu, Olamaboro Local Government area of Kogi State in bone fracture treatment and dislocation. The study was carried out between May through September 2019. Ethnomedicinal knowledge was gathered from 20 traditional bone setters in 10 communities using questionnaires. The plants most referenced from the questionnaire were collected and identified using various standard methods and procedures. 80% of the respondents were male while 20% were female. 40% were in the range of 31-41 years of age and only 10% were in the age range of 20-30 years. About 45% has no formal education while only 5% had a university degree. TBS with most year of experience (21-25 years) are only 5% while the profession is dominated by those of moderate time of practice (11-15 years) with 40% representative. A total of 49 medicinal plant species distributed in 27 families and genera were documented. Family Euphorbiaceae was found to be mostly used for fracture treatment. The most frequent used plant parts were the leaves (49.5%). The method of preparation of the herbal remedies were generally best in the form of poultice administered in the form of paste to give the best result in fracture and bone setting treatment.

Frequency of Complications among Trauma Patients Treated by Traditional Bone Setters Presented to Orthopedics Department, Gujranwala Teaching Hospital Gujranwala.

Background: Traditional bone setters (TBS) are widely consulted for trauma care in developing regions, often leading to severe complications due to inadequate medical knowledge. This practice poses significant risks to patient safety and outcomes. Objective: The study aimed to evaluate the frequency and nature of complications encountered by trauma patients treated by traditional bone setters. Methods: This cross-sectional study was conducted in the Department of Orthopedics and Trauma Surgery at Gujranwala Teaching Hospital, Pakistan, from February 1st to April 31st. Ninety-seven patients who received care from TBS and subsequently presented at the Orthopedic outpatient clinic were included. Detailed data on demographics, injury type and site, TBS management techniques, and resulting complications were collected and analyzed using SPSS Version 20. Results: Among the 97 patients, 63 (64.95%) were female and 34 (35.05%) were male, with ages ranging from 3 to 70 years and a mean age of 33. TBS primarily used sticks and bandages for fracture management. The most common complications were malunion (42.27%), non-union (21%), and joint stiffness (17%). Conclusion: The high incidence of complications from TBS treatments significantly strains the Orthopedics department. Proposed solutions include integrating TBS into the healthcare system for improved training and regulation or implementing a complete ban on their malpractices.

Knowledge, attitude and practice of traditional bone setting among adults Sudanese in Khartoum: a cross sectional study

Knowledge, attitude and practice of traditional bone setting among adults Sudanese in Khartoum: a cross sectional study

Training Traditional Bonesetters in Basic Principles of Fracture Treatment: A Proof of Concept in Ghana.

Our study assessed the effectiveness of a traditional bonesetter (TBS) educational program that was designed to increase knowledge, reduce complications, and promote the referral of patients to local hospitals by TBSs when necessary. From April to December 2021, TBSs from the Northern Sector (the Northern, Savannah, and North East regions) and the Ashanti region of Ghana underwent a 4-day training course that had been designed to teach basic principles of fracture care with the use of local tools. We assessed the levels of knowledge of the TBSs both before and after training. The change in practice of the trained TBSs also was assessed at 6 months using a structured questionnaire and a checklist. In total, 157 TBSs were trained in 5 training sessions over a 9-month period. There was an improvement in knowledge in all of the modules of training, with an overall knowledge gain of 19.7% (from 67.2% to 86.9%). At 6 months of follow-up, the practices of TBSs that had most improved were record-keeping, hand hygiene, and patient rehabilitation. As a result of the referral system that was established by the training project, a total of 37 patients were referred to local hospitals in the 6 months following the training. Formal training for TBSs that was provided by a multidisciplinary team with use of a locally developed curriculum and tools was effective in improving the practice and outcomes of treatment by TBSs. There was marked knowledge retention by the trained TBSs at 6 months after training in fracture management. Education, training, and the establishment of referral pathways between TBSs and local hospitals could improve trauma care in Ghana.

Fractures in sub-Saharan Africa: epidemiology, economic impact and ethnography (Fractures-E3): study protocol

Background: The population of older adults is growing in sub-Saharan Africa. Ageing exponentially increases fragility fracture risk. Of all global regions, Africa is projected to observe the greatest increase in fragility fractures. Fractures cause pain, disability and sometimes death, and management is expensive, often requiring complex healthcare delivery. For countries to plan future healthcare services, understanding is needed of fracture epidemiology, associated health service costs and the currently available healthcare resources. Methods: The Fractures-E3 5-year mixed-methods research programme will investigate the epidemiology, economic impact, and treatment provision for fracture and wider musculoskeletal health in The Gambia, South Africa and Zimbabwe. These three countries are diverse in their geography, degree of urbanisation, maturity of health service infrastructure, and health profiles. The programme comprises five study types: (i) population-based cross-sectional studies to determine vertebral fracture prevalence. Secondary outcomes will include osteoarthritis and sarcopenia. Age- and sex-stratified household sampling will recruit 5030 adults aged 40 years and older; (ii) prospective cohort studies in adults aged 40 years and older will determine hip fracture incidence, associated risk factors, and outcomes over one year (e.g. mortality, disability, health-related quality of life); (iii) economic studies of direct health costs of hip fracture with projection modelling of future national health costs and cost-effectiveness analyses of different hip fracture care pathways; (iv) national surveys of hip fracture services (including traditional bonesetters in The Gambia); and (v) ethnographic studies of hip fracture care provision and experiences will understand fracture service pathways. Conclusions: Greater understanding of current and expected fracture burdens, fracture risk factors, and existing fracture care provision, is intended to inform national clinical guidelines, health service policy and planning and future health service development in sub-Saharan Africa.

Generalized tetanus in a farmer following treatment of an open ankle fracture by a traditional bone setter

Key Clinical MessageThis is the case of a 31‐year‐old farmer diagnosed with an open right ankle fracture and tetanus sustained from an accident after opting for traditional bonesetter treatment. Open fractures increase the risk of tetanus infection therefore herbal treatment should be discouraged. Source control is important for holistic management of tetanus.

Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia

World Health Organization stated that traditional medicine is an important part of health care and countries need to consider integrating it into their primary health care system. Traditional bone setting has a long history in Ethiopia and it enjoys enormous acceptance in the community. However, these methods are raw, there is no standardized training and at the same time, complications are common. Therefore, this research aimed to assess the prevalence of traditional bone setting service utilization and associated factors among people with trauma in Mecha district.Methods A Community- based cross-sectional study design was employed from January 15 to February 15, 2021. A total of 836 participants were selected using a simple random sampling technique. Binary and multiple logistic regressions were employed to assess the association between the independent variables with traditional bone setting service utilization.Results The prevalence of traditional bone setting service utilization was 46.05%. Factors significantly associated with TBS utilization were: Age ≥ 60 years (AOR = 0.13, 95% CI: 0.03- 0.43), rural residence (AOR = 3.63, 95% CI: 1.76 -7.50), occupation (merchant (AOR = 0.21, 95% CI: 0.07 -0.61), and housewife (AOR = 4.12, 95% CI: 1.33 -12.70), type of trauma: dislocation (AOR = 6.40, 95% CI: 3.69–11.10), and strain (AOR = 2.09, 95% CI: 1.05- 4.14)), site of trauma: extremity (AOR = 0.20, 95% CI: 0.11, 0.37), trunk (AOR = 0.08, 95% CI: 0.03–0.22), and shoulder (AOR = 0.20, 95% CI: 0.11–0.37), cause of trauma: fall down and natural deformity (AOR = 9.87, 95% CI: 5.93–16.42) and household annual income greater than > 36,500 (AOR = 2.33, 95% CI: 1.29–4.22).Conclusion The prevalence of traditional bone setting practice is high in the study area, despite recent advancements in the practice of orthopedics and trauma in Ethiopia. Since TBS services are more accepted in society, the integration of TBS into the health care delivery system is recommended.

Traditional Health Care Practitioners' Perspectives on Applying Informed Consent During African Traditional Medical Practice in Akwa Ibom State, Nigeria: A Cross-Sectional Qualitative Study.

Introduction: This study explored the perspectives of traditional health care practitioners (THPs) practicing in the areas of herbalism, bone setting, and traditional birth attendance, from Akwa Ibom state, Nigeria, on the possibility and implications of applying informed consent (IC) during African traditional medicine (ATM) practice. Methods: Semistructured interviews were conducted with 11 THPs, consisting of 5 herbalists, 3 traditional bone setters (TBS), and 3 traditional birth attendants (TBAs), who represented the diverse groups that the study intended to cover. In-depth interviews were conducted using a semistructured guide and were recorded, transcribed, and analyzed using thematic analysis with the assistance of NVivo® qualitative analysis software. Results: Participants were seven males (64%) and four females (36%), 35-67 years of age, with 5-25 years of experience as THPs. Forty-six percent of participants were herbalists (27%), TBS, and TBAs (27%). Most participants (82%) were Annang, and (18%) were Ibibio first-language speakers. Three major themes emerged from the data analysis: (i) Existing ethical framework related to IC, (ii) knowledge of consent, and (iii) application of IC during traditional medical practice. These themes and relevant subthemes were explored. All (100%) THPs agreed that it was essential to communicate risks and benefits while allowing patients to ask questions before treatment. All participants (100%) stated that risk communication is essential in ATM, whereas 36% said they communicated all therapy benefits to their patients. Respondents believed patients could make an informed choice if they had complete information disclosure. However, THPs in this study had limited knowledge of formal IC rules and regulations. Conclusions: This study revealed that THPs in this setting disclose a diagnosis, risks, some benefits, and treatment options to patients. Consent/agreement was obtained verbally and voluntarily during ATM practice, consistent with IC doctrine. THPs had limited knowledge of the critical elements of IC. However, they suggested that a form of IC that does not conflict with traditional African norms could be applicable in ATM. IC could facilitate documentation and help reduce risks in ATM practice.

Analysis of the Influence of Traditional Bone Setting and Loosening Manipulation of Traditional Chinese Medicine on Sports Rehabilitation after Ankle Operation

Objective: To explore the clinical effect of traditional Chinese osteosetting and loosening manipulation after ankle surgery and its influence on rehabilitation. Methods: From September 2022 to March 2023, 70 patients with ankle joint injuries admitted to Longzihu Campus Branch of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected, all of whom received surgical treatment. They were divided into the research group and the control group according to the digital double-blind grouping method, with 35 patients in each group. After the operation, traditional bone setting relaxation and conventional rehabilitation therapy were adopted respectively. The effects of rehabilitation therapy, clinical symptom scores and quality of life of the two groups were compared. Results: The excellent and good rate of the study group was 94.29%, which was significantly higher than that of the control group (77.14%); After treatment, the clinical symptom score of the control group was higher than that of the study group, and the quality of life score was lower than that of the study group (P<0.05), which was statistically significant. Conclusion: The application of traditional Chinese medicine bone setting relaxation method in the postoperative rehabilitation treatment of patients with ankle joint injury can improve the treatment effect, improve the ankle joint function of patients, and accelerate the recovery of patients, which is worthy of promotion.

Traditional bonesetters clinics: Prospective trends and work assessment on 915 bonesetters operating in parts of Uttar Pradesh and Haryana, India

Introduction: In India, majority patients with musculoskeletal injuries are attended by traditional medicine treatment provider. Bone setting services data from Subcontinent is not available. Methods: Prospective epidemiological study across 10 cities. Objective: To document bonesetter's spectrum of services and work-based information; radiological services use, treatment methods, treatment cost, treatment duration, referral timing, complication incidence and success rates. Results: Study encompasses 915 Traditional Bone Setters working over area of 6725 km2. Meerut houses most bonesetters (n=130); industry dominated by men (98.5%). 55% bonesetters are of 51-70 years. Overall experience 53.75 years. 9.50 % Bonesetters have radiograph machines. 55.95% practicing bonesetters are 3rd generation lineage. 32.67% bonesetters prescribe allopathic medications. For treatment, Males visit more (55%) followed by Females (25%) and Third gender (15%) patients. Patients age group 5-94 years. 22.4 patients visit each bonesetter daily. An average treatment lasts 4-5 sessions; treatment cost 300-400 Indian Rupees per sitting (3.60-4.80 USD). Patient report 2.75 days post injury & treatment lasts 14.5 days. 90% Bonesetters take time till 3rd bandage (9-10days) to decide on referral. Patient's satisfaction is 64% and 45% complication rates. Discussion: Traditional Bone Setters form largest specialised group offering services for musculoskeletal injuries in India; attracting 25-40 patients per practitioner daily. High complication and referral rates are worrisome. Conclusion: Clientele visiting bonesetters form major chunk of patients that should be treated by Orthopaedic Surgeons. Policies should be made to integrate bonesetters into structured health services; to benefit community at larger scale with fewer complications and man hours lost to work.

Solid locked intramedullary nailing for expeditious return of bone-setting-induced abnormal fracture union victims to work in South-western Nigeria

Wage earning in low- and middle-income countries (LMICs) is predominantly through physical labour. Consequently, limb-related disabilities caused by abnormal fracture unions (AFUs) preclude gainful employment and perpetuate the cycle of poverty. Many AFUs result from traditional bone-setting (TBS), a pervasive treatment for long bone fractures in LMICs. The objective of this study was to accentuate the expediency of solid locked intramedullary nail in the early restoration of victims of TBS-induced abnormal fracture unions (AFUs) to their pre-injury functioning, including work. One hundred AFUs in 98 patients treated with a solid locked intramedullary nail in our center over a period of 7 years were prospectively studied. We found the mean age to be 47.97 years. Males constituted 63.9% of the patients’ population. Atrophic non-union accounted for 54.1% of the AFUs. The mean fracture-surgery interval was 21.30 months. By the 12th post-operative week, more than 75% of the fractures had achieved knee flexion/shoulder abduction beyond 90°, were able to squat and smile (or do shoulder abduction-external rotation), and were able to bear weight fully. The study demonstrated the expediency of solid locked nail in salvaging TBS-induced abnormal fracture unions in a way that permitted early return to pre-injury daily activities and work, thereby reducing fracture-associated poverty.