Traditional Bone Setters Research Articles

Open Reduction on very late-presenting unreduced posterior elbow dislocation: Still promising treatment option

BackgroundNeglected dislocation of the elbow is associated with instability, pain, and limitation of elbow function. In developing countries, neglected dislocations of the elbow are quite common, and most patients initially go to local bonesetters, which only aggravates the problem. Presentation of caseTwo patients with a history of unreduced posterior elbow dislocation for more than 1 year and were treated by a traditional bonesetter were included in this case study. The first case was a 65-year-old female with a history of injury around her right elbow around 12 months before admission. The patient underwent open reduction with triceps lengthening and immobilization with plaster of paris for 3 weeks. The second case was a 53-year-old male with a history of injury caused by a fall on an outstretched hand around 18 months before admission. The patient underwent arthrolysis followed by triceps lengthening, internal fixation with transarticular k-wire, and immobilization with elbow slab for 3 weeks. DiscussionTo optimize treatment goals and patient function, various surgical approaches have been described for treating chronic elbow dislocations. The benefit of the VY triceps lengthening is to simplify the reduction procedure, especially in the elbow dislocations with greater chronicity. The downside of the VY lengthening is possible triceps weakness, delayed physiotherapy, and increased postsurgical pain. On the basis of this study, open reduction should remain a treatment option for patients regardless of age and chronicity of injury. ConclusionOperative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable, and functional limb.

Radiation-free interlocking intramedullary nailing of three-hundred and seventy long bone fractures in Ogbomoso, Nigeria

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.

Are Medical Students willing to Patronize Traditional Bone Setters in the Future? A Study among Medical Students of Ebonyi State University Abakaliki, Nigeria

Background: A large proportion of fractures are still managed by traditional bone setters in developing nations. The study was designed to determine the willingness to patronize traditional bone setters in the future among medical students of Ebonyi State University Abakaliki, Nigeria.Methods: This was a descriptive cross-sectional study of all preclinical and clinical medical students of the university. Information was obtained using a pretested, self- administered questionnaire. Data were analyzed using IBM SPSS statistical software version 22.0 and level of statistical significance was determined by a p value of < 0.05.Results: A total of 385 students participated in the study (response rate; 83.7%). Mean age of respondents was 23.2±3.4 years. One quarter of the respondents, 82 (25.0%) have patronized traditional bone setters before. About half indicated that traditional bone setters receive more patronage than orthopedic surgeons, however three-quarters of them preferred services of Surgeons. Two-thirds opined that bone setters have more treatment failures, and only 72 (18.7%) were willing to patronize traditional bone setters in future. Major reasons to patronize them included skilled/good service delivery, 34 (47.2%) and low cost, 21 (29.2%). Predictor of willingness to patronize traditional bone setters in future was previous use of traditional bone setters, (AOR=8.3, 95%CI: 4.7-14.9, p<0.001)Conclusion: The practice of traditional bone setting is widespread and enjoys much acceptance in the society despite high rates of treatment failures associated with it. Thus, there is the need to monitor the activities of traditional bone setters to enhance competence and encourage referral.

Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania.

Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health. Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives. We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method. Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-administered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67). Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on traditional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.

Reasons for Patronage of Traditional Bone Setting as an Alternative to Orthodox Fracture Treatment A case of Muleba District, Kagera Tanzania

Reasons for Patronage of Traditional Bone Setting as an Alternative to Orthodox Fracture Treatment A case of Muleba District, Kagera Tanzania

Traditional bone setting: an avoidable cause of major limb amputations

<p><strong>Background: </strong>Despite the availability of modern health care services, patients in Nigeria still seek treatment by traditional bone setters. One of the major complications of this type of native fracture treatment is limb gangrene necessitating amputations. The objective of this study was to determine the role of traditional bone setting in major limb amputations.</p><p><strong>Methods: </strong>This retrospective study was carried out at a government orthopedic referral hospital. The study involved all patients who underwent major limb amputation between January 2015 and December 2019 in our center. Data were retrieved from medical records and operation registers. Information regarding age, sex, indications and levels of amputation and complications were studied.</p><p><strong>Results: </strong>During the study period; of the 297 major limb amputations performedd, 194 (65.3%) were due to traditional bone setting. The median age of the patients was 11.0 years (1 to 45 years) and the interquartile range was 10 years. Majority of the patients 86 (44.3%) affected were children less than 10 years of age. Male were more affected than female (M:F=1:2). Lower limb is more affected than the upper limb. The commonest amputation done was below knee amputation in 79 (40.7%) of cases. The commonest complication was surgical site infection which occurred in 32 (16.5%) patients.</p><p><strong>Conclusions: </strong>Traditional bone setting is a leading cause of major limb loss especially in children.</p>

Assessment of the Maya’s Beliefs and Preferences on Bonesetters and Bone Fracture Treatment in the Guatemalan Highlands: A Household Survey

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.

Unregistered Traditional Bone Setting Practice in Aceh, Indonesia: A Problem that Need to be Solved?

Little is known about traditional bone setting (TBS) practise in Aceh, Indonesia despite of its common utilisation. The aim of this study was to explore the characteristics of TBS practise in Aceh, Indonesia. Thirty-nine participants from ten regencies in Aceh were interviewed from January to December 2019. Most of the participants were male (82.1%), and aged between 31-50 years old (79,5%). Half of the participants were elementary school graduates (51,3%). More than half (59%) of participants had been practicing bone setting for 5-10 years, and many of them (48.7%) used traditional massages combined with splints and herbal mixtures. None (0%) of the participant obtained legal permission to practice bone setting. More than half (71.8%) obtained the knowledge of TBS from their ancestral heritage, only one participant obtained it through apprenticeships. We concluded that TBS practices in Aceh were unregistered, and the practitioners were mostly untrained. There is a need to provide training and permits for TBS practise to ensure patients’ safety.

Fracture nonunion.

A fracture that lasts for a minimum of nine months without signs of healing for three months is the standard description of nonunion. Plethora of literatures highlights the determinants that increase the risk of nonunion as infections, older age, diabetes, anti-inflammatory drugs, use of tobacco/nicotine, open/compound fracture, low vitamin-D, hypothyroidism, poor nutrition, severe anaemia, etc. Apart from these, there are hidden factors influencing the occurrence of nonunion. This article emphasises on such hidden factors. This case is a 70 year old man who came with complaints of cold and cough. Incidentally, the abnormal appearance and mobility in the forearm was noticed (A). Further history revealed that, the patient had a past history of road traffic accident 10 years back, followed by which he took native treatment from traditional bone setters. He´s a known case of diabetes, hypertension. On examination, patient had painless abnormal movement in the upper 1/3rd of the forearm. The distal part of forearm was moving horizontally, vertically and rotationally. Radiological image shows complete fracture of both bones in forearm (B). In fracture treatment, patient compliance is very crucial. In this case, the patient was initially treated by a local traditional bone setter. The patient is unaware of the treatment options available in modern medicine for such fractures. The patient´s poor socioeconomic status, nutritional status, smoking habit (30 years) also played a vital role in poor bone healing. In developing countries like India, this case scenario throws light on the huge lacunae in health education and perception regarding fracture management among people in the rural areas.

Comorbidity profile of Siddha Varmam therapy patients and insight into integrative pain management: A cross sectional study

Introduction: Traditional medical system is one of the centuries old practices and serving mankind to fight against disease. Siddha System of medicine is one among the Indian system of medicine popular in India and other Tamil speaking countries. Varmam therapy, which is unique to Siddha System, which involves manipulation of life energy points in the body. Methods: Objective: To explore the comorbidity of the patients with musculoskeletal disease conditions and insight into integrative pain management. Design: Cross sectional study. Setting: Siddha Varmam Thokkanam and Traditional Bone setting (VTTB) division out-patient department, at Siddha Central Research Institute, Chennai, during the July to December 2019. Results: There were 1592 adult patients, of which 830 were male and 762 were females and majority of them were in the age group 51-60 years (32.53%) and 25.75% in the age group 61-70years and 22.8% in 41-50 years age group. 55.4% of patients visiting the facility were within 10km distance from their residence while 3.84% were travelling more than 100km to reach the facility. 60.18% of the patient had diabetes, 50.31% had hypertension, 9.8% hypothyroidism, 4.45% cardiovascular disease, 22.5% had combined diabetes and hypertension, for which, 10.65% was taking only siddha medicine for their diabetic control and 15.97% were on integrative treatment, allopathy and Siddha medicine for their diabetic control. Conclusion: The present study insists to consider the comorbid conditions of patients visiting Siddha health facilities across the state and projecting integrative Siddha Varmam therapy for pain considering comorbidities irrespective of pharmacological interventions.

Valgus Osteotomy with DHS Fixation in the Management of Malunited Intertrochanteric Fractures in a Rural Population.

Introduction:Malunited intertrochanteric fractures are frequently seen in rural populations as they tend to go in for native treatment with traditional bone setters. The resulting Coxa vara is associated with shortening, abductor weakness, limp and decreased range of movement of the affected hip. The aim of this study was to evaluate the role of Valgus osteotomy with Dynamic hip screw (DHS) fixation in the management of these fractures and to evaluate the functional outcome using the Harris hip score.Materials and Methods:Fifteen patients with malunited intertrochanteric fractures who presented between January 2011 to January 2013 were managed by Valgus osteotomy with DHS fixation and were followed-up for a minimum period of three years.Results:There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The duration of native treatment ranged from seven to 12 weeks and the time of presentation to the hospital ranged from four to nine months following injury. Pre-operative mean neck shaft angle was 94.73° while it was 134.6° post-operatively. The mean pre-operative Harris hip score was 72.33 and it was 91 at follow-up. All patients were happy with the procedure and the functional outcome.Conclusion:Valgus osteotomy with DHS fixation is an effective procedure in the management of malunited intertrochanteric fractures. It corrects the limb length discrepancy, restores the decreased neck shaft angle, improves range of movement, restores the integrity of the abductor mechanism of the hip and gives good functional results.

Functional outcome of arthroscopic reconstruction of chronic anterior cruciate ligament ruptures using single-bundle triple-weaved hamstring tendons in northern Nigeria

Though anterior cruciate ligament (ACL) is the most commonly reconstructed ligament all over the world, its arthroscopic reconstruction was relatively less frequent in the West African sub region until recently. The patronage of the traditional bone setters in the acute phase of closed knee injuries has made Chronic ACL injury the main form of presentation with significant secondary injuries and degenerative changes from sub-optimal initial care. The aim of this study was to determine functional outcome and patient’s satisfaction from Arthroscopic chronic ACL injury repair. Diagnoses were made using clinical parameters and MRI. Lysholm scores were determined preoperatively, and repeated with patient’s satisfaction assessment (using the Likert scale) at 3, 6, 12, 24 and 48 months postoperatively. Arthroscopic single-bundle ACL repair using a triple-weaved hamstring tendon (s) was done for all the patients. Debridement and meniscectomy were done for various degrees of degenerative changes and irreparable meniscal injuries respectively. No one was dissatisfied and 91.4% of the patients had well to excellent Lysholm scores at 2 years of follow up. It was concluded that arthroscopic chronic ACL rupture reconstruction using single-bundle triple-weaved hamstring autografts with good rehabilitation offers good to excellent knee function and patients’ satisfaction with minimal complications.

To determine efficiency of Ilizarov's circular external fixator in form of the bone outcome and functional outcome in treatment of femoral and tibial nonunions

Aim: planned to assess bone and functional outcome of Ilizarov's circular external fixator in treatment of femoral and tibial nonunion (infected and noninfected both). Material and methods: The present study is clinical prospective type of study conducted at Dr Hardas Singh Orthopaedic Hospital & Superspeciality Research Centre, Amritsar, Punjab. The present study included 15 cases, all managed with Ilizarov circular external fixator for isolated femoral or tibial nonunion after obtaining informed consent, clinical and radiological examination during a period of 24 months. After removal of frame, patient followed up regularly every month and we assessed them for bony and functional outcome. Results: The age of patients in present study was 22 to 55 years with mean age of 39.4 years. There were 3 (20%) femoral and 12 (80%) tibial nonunions that were operated with Ilizarov’s circular external fixator using ilizarov method’s. Road traffic accidents were the most common mode of injury accounting for 11 cases (73.3%). Fourteen patients had undergone fixation previously (plate osteosynthesis = 7, external fixators of the AO tubular type = 7) and one patient had been treated by traditional bonesetter bandages. According to ASAMI guidelines, bone outcome was excellent in 7 cases (46.6%), good in 5 cases (33.3%), fair in 2 (13.3%) cases and poor in 1 case (6.7%). Functional outcome was excellent in 3 cases (20%), good in 11 cases (73.3%), fair in no case and poor in 1 case (6.7%). But no patient required amputation. Conclusion: Ilizarov technique using circular external fixator is a good salvage operation for infected and noninfected nonunion of the femur and tibia both. Functional results can be improved by the early use of the Ilizarov technique.

Factors affecting utilization of traditional bonesetters in the Northern Region of Ghana.

BackgroundTraditional bonesetters (TBS) are still highly patronized by people with fractures in Africa. We sought to investigate factors affecting the utilization of TBS services in the Northern Region of Ghana.MethodsA mixed-methods study that combined both qualitative and quantitative approaches was conducted among 64 TBS clients in the Northern Region of Ghana. Participants were purposively selected and should have utilized the services of TBSs at the time of the study. In addition, three focus group discussions (FGDs) were conducted to complement the quantitative results. Quantitative analysis was performed by calculating means and proportions. For the qualitative data, content analysis was done manually based on emerging themes in line with the study objectives.ResultsSixty-four (64) clients were recruited. Twenty-four (37.5%) were female. The modal age group was 19–39 years. The educational status of the clients was dominated by primary/junior secondary education (39.1%), but included the full spectrum from no formal education / illiterate (26.6%) to tertiary (12.5%). Cheaper fees (26.3%), cultural beliefs (17.9%), and quick service (15.9%) were the main reason of patronizing TBSs. Twenty-two (34.3%) would have preferred orthodox care and the reasons cited included availability of X-rays (27.3%) and pain management (25.3%). These themes were reiterated by FGDs with an additional 30 clients. Additional themes identified by the FGDs included a belief that TBSs address both physical and spiritual aspects of the injury and the major role that families (not the injured person alone) make in deciding on type of treatment. Clients were supportive of orthodox providers linking with TBSs for activities such as training to improve pain control.ConclusionTBSs have patronage from the full spectrum of society. The decision to opt for TBS treatment was influenced by cheaper fees, cultural belief, and quick service. TBS clients wanted greater linkages between TBSs and orthodox providers.

Epidemiology of Femur Fractures in Children: A Descriptive Cross Sectional Study Based on a Rural Population of Nepal.

Femur fracture in children is one of the most common lower limb fractures which require inpatient care. The aim of this study is to determine the epidemiology of femoral shaft fractures in children from a rural population of Karnali Nepal. Hospital records were retrospectively reviewed from May 2017 to April 2020 to identify all the children with femur fracture. Sociodemographic profile, mode of injury, fracture pattern and location, time of presentation, initial treatment by traditional bone setters, treatment method and duration of hospital stay were noted. Data analysis was done using Statistical Package for Social Sciences version 20. Altogether 104 children were identified. The mean age was 5.55 years and boys predominated 65 (62.5%). Falls were the major mode of injury in 65 (62.4%) patients. Fractures were frequently noted between April 15 to August 15. There were four (3.8%) open fractures and concurrent fracture observed in eight (7.6%) patients. Ten (9.6%) children received prior treatment from traditional bonesetters. Treatment methods included hip spica 62 (59.6%), elastic intramedullary nailing 30 (28.8%) and plate fixation 12 (11.5%). The duration of hospital stay in the nailing and plate fixation group was 11.43 days and 18 days respectively. Fracture was common in 2-6 years of age group in boys during summer. Fall from cliff, rooftop and ladder were the major preventable cause of fracture. Delayed presentation and prior treatment with traditional bone setters add special challenges to orthopedic surgeons working in rural teaching hospital.

Practices and Perspectives of Traditional Bone Setters in Northern Tanzania.

Background:Traditional health practitioners remain a critical source of care in Tanzania, more than 50% of Tanzanians frequently using their services. With a severe shortage of orthopaedic surgeons (1:3.3 million Tanzanians) traditional bone setters (TBSs) could potentially expand access to musculoskeletal care and improve outcomes for morbidity as a result of trauma.Objective:We sought to identify the advantages and disadvantages of traditional bone setting in Tanzania and to assess potential for collaboration between TBSs and allopathic orthopaedic surgeons.Methods:Between June and July 2017 we interviewed six TBSs identified as key informants in the regions of Kilimanjaro, Arusha, and Manyara. We conducted semi-structured interviews about practices and perspectives on allopathic healthcare, and analyzed the data using a deductive framework method.Findings:The TBSs reported that their patients were primarily recruited from their local communities via word-of-mouth communication networks. Payment methods for services included bundling costs, livestock barter, and sliding scale pricing. Potentially unsafe practices included lack of radiographic imaging to confirm reduction; cutting and puncturing of skin with unsterile tools; and rebreaking healed fractures. The TBSs described past experience collaborating with allopathic healthcare providers, referring patients to hospitals, and utilizing allopathic techniques in their practice. All expressed enthusiasm in future collaboration with allopathic hospitals.Conclusions:TBSs confer the advantages of word-of-mouth communication networks and greater financial and geographic accessibility. However, some of their practices raise concerns relating to infection, fracture malunion or nonunion, and iatrogenic trauma from manipulating previously healed fractures. A formal collaboration between TBSs and orthopaedic surgeons, based on respect and regular communication, could alleviate concerns through the development of care protocols and increase access to optimal orthopaedic care through a standardized triage and follow-up system.

Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report

The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters.Case Presentation:A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release.Discussion:Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal.Conclusion:Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen

Clinical and Demographic Profile of Volkmann's Ischemic Contractures Presenting at National Institute of Rehabilitation Medicine, Islamabad, Pakistan.

BACKGROUNDEstablished Volkmann’s ischemic contractures (VICs) represent the eventuality of neglected acute compartment syndrome (ACS) of the forearm. This study assessed the clinical and demographic presentation of VICs. METHODSThis study was conducted at Department of Plastic Surgery, National Institute of Rehabilitation Medicine, Islamabad, Pakistan over a period of three years and included all patients of either gender who presented with VICs and analyzed various corrective procedures instituted as surgical remedies.RESULTSAmong 37 included patients, 83.78% were male and 16.21% were female (mean age: 16.51±9.1 years). The underlying causes of the initial traumatic insults were tight bandages employed by traditional bone setters for treating forearm fractures (83.78%), high voltage electric burns involving hands/forearms (13.51%) and supracondylar fracture with vascular compromise (2.70%). Majority of patients belonged to Holden type 2 (97.29%) and Tsuge type 2 VICs (48.68%). The most common sufferers of VICs were young, illiterate males coming from rural regions. Treatment for forearm fractures by traditional bonesetters constituted the most common underlying cause. Most of the patients were managed with combination of procedures including tendon transfers, excision of the fibrosed muscles, tenolysis and neurolysis of median and ulnar nerves. Tendon transfers were the commonest corrective procedures instituted.CONCLUSIONThis study highlighted the gravity of this largely preventable but neglected catastrophe and there is a need to institute robust preventive measures to address the issue. Emphasis should be on creation of public awareness and robust education of health care providers to ensure correct primary management of upper limb trauma.

Knowledge and Attitude about the Practice of Traditional Bone Setters and Its Use for Musculoskeletal Disorders in Rural Areas in Nigeria

Background: Vacillation between conventional healthcare professionals and traditional bone setters (TBS) for musculoskeletal (MSK) disorders is still common despite shortcomings and complications associated with TBS services. Objectives: This study assessed knowledge and attitude about the practice of TBS and its use for MSK disorders among Nigerian rural dwellers. Methods: This cross-sectional study utilized a multistage sampling method based on the World Health Organization procedures for a community-based survey to recruit 398 (213 males and 185 females) respondents from two randomly selected rural communities. A validated questionnaire adapted from relevant previous studies was used as a tool in this study. A household was served as the Primary Sampling Unit (PSU) and 60 PSUs were randomly selected. Results: The lifetime and 12-month prevalence of MSK disorders were 27.6% and 25.6%, respectively. Based on 12-month prevalence, neck (16, 21.6%) and shoulder (12, 17.6%) were the most affected body parts. The lifetime (i.e. “ever use”) and point (“current use”) prevalence of treatment by TBS were 19.3% and 3.8%, respectively. Among those who had ever experienced MSK disorders, 13.3% had experienced only treatment by TBS services, whereas 6.0% had used both treatment by TBS and orthodox medicine. Common services received by TBS were massage (61.0%), splinting (14.3%), traction (11.7%), and scarification (10.4%). Cost-effectiveness (42.9%), distance/accessibility (35.1%), and cultural beliefs (15.9%) were the major reasons for TBS patronage. Using TBS services was not significantly associated with socio-demographic variables (P > 0.05). Also, 57.3% of the respondents acknowledged that TBS services were associated with complications, such as gangrene (19.7%), malunion/nonunion of fractures (36.0%), paralysis (19.3%), joint instability (7.5%), and chronic osteomyelitis (6.6%). Users of the TBS services believed that they were effective in maintaining a healthy life (40.7%), with fewer side effects (30.0%), more effective (11.7%), and healthier than orthodox medicine (23.1%). Conclusions: There was a positive attitude towards treatment by TBS for MSK disorders, despite the complications and shortcomings that arise from the practice. Cost-effectiveness, socio-cultural beliefs, and easy access have increased patronage of treatment by TBS regardless of the socio-demographic characteristics of the people.

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.