Traditional Bone Setters Research Articles

The prevention of traditional bone setter’s gangrene

A two-year retrospective survey in southern Ethiopia revealed that 49 amputations had been performed, 25 of which were for gangrene following tight splintage applied by traditional bone setters. The aim of this study was to determine if it was possible to reduce this incidence of gangrene by offering one-day instructional courses to bone setters. In ten separate one-day courses 112 tradition healers attended. In addition, two-day courses were given to local health assistants, who also received written instructions for the safe care of fractures. A two-year prospective study revealed a marked reduction in amputations, from 49 to 25, with only seven rather than 25 being required for gangrene. We found that it is possible to educate traditional healers so that fewer gangrenous limbs require to be amputated.

Femoral neck fractures: A prospective assessment of the pattern, care and outcome in an orthopaedic centre

OBJECTIVE: To review the pattern of femoral neck fractures, complications and outcome following fixation with Austin-Moore endoprosthesis. METHOD: A two year prospective study in patients who had fracture of the femoral neck based on strict inclusion criteria. All the patients were treated by Austin-Moore hemiathroplasty via the classical southern approach. Complications were ocumented as they developed and probable causative factor evaluated. Minimum follow up was 32 completed weeks. OUTCOME MEASURES: Interval between surgery and mobilization, return to full activity and modification of lifestyle after surgery. RESULTS: Thirty patients were recruited, 21 males and 9 females with a mean age of 67.4 years. Twenty (66.7%) sustained injuries in a road traffic accident. Garden's grade 3 and 4 were the most common types. The presence of co-morbid factors and initial management by traditional bonesetters caused delay in instituting definitive surgery. Infective complication was the most common complication; mainly post operative wound infection (20.0%) urinary tract infection (23.3%) and upper respiratory tract infection(30.3%).Existing co-morbid factors, prolonged pre-operative stay, duration of operation and invasive ancillary procedures were responsible for these. Twenty (66.7%) patients had returned to full mobilization at 12 weeks of follow-up. CONCLUSION: Austin-Moore hemiathroplasty is the preferred choice of fixation in elderly Nigerians especially if displaced. Correction of co-morbidfacors pre-operatively, antithrombotic prophylaxis, perioperative antibiotics and early mobilization should form the cornerstone of treatment if good outcome is to be expected. KEY WORDS: Femoral neck, Austin-Moore endoprosthesis, co –morbid factor. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 42-49

The role of the traditional bonesetter in primary fracture care in Nigeria.

In view of the growing interest in the management of fracture worldwide, the traditional bonesetter (TBS) practice in Nigeria was documented. To highlight the role of the TBS in primary fracture care in Nigeria. Rural. Over a 5-year period a qualitative study of the TBS settings and knowledge, diagnostic techniques and principles of fracture treatment in four TBS centres in Nigeria was carried out by active participation, on the spot assessment, interactive dialogues and oral interviews. It was found that TBS services are well preserved as a family practice, and training is by apprenticeship. Records are kept by oral tradition. There is no prescribed fee and the patronage is high. Fracture diagnosis is based on physical assessment and experience. The TBS relies solely on the conservative method of fracture treatment, and all fractures are reduced by the closed method and stabilised with an external traditional splint and a protracted period of immobilisation. The outcome of TBS treatment is good for closed fractures of the shaft of the humerus, ulna, radius and tibia, but poor for peri-articular and open fractures. Non-union, malunion, traumatic osteomyelitis and limb gangrene were the common major complications of TBS treatment. Despite criticisms and antagonism from orthodox medical practitioners TBS practice is well patronised by Nigerians. In order to guarantee safety and efficiency of the TBS practice in primary fracture care service delivery in Nigeria, there is therefore a need both to educate the community and to train the TBS.

Pattern And Outcome Of Treatment Of Musculoskeletal Conditions By Traditional Bonesetters In Southwest Nigeria

OBJECTIVE: Complications of treatment by traditional bonesetters (TBS) of musculoskeletal injuries and diseases are not infrequently seen in modern orthopaedic practice in developing countries. The TBS are still being patronized despite the array of complications arising therefrom. Also they treat musculoskeletal conditions other than fractures. METHODS: A prospective descriptive study was conducted on patients who had earlier been treated by the TBS, using interviewer-administered questionnaire, to identify the types of conditions treated by the TBS and the complications arising there from. RESULTS: Forty-one patients, mostly Yoruba of South-West Nigeria were studied. Fractures, especially of the femur were the most common conditions treated by the TBS, representing 71% of all conditions. Others include soft tissue injuries 9.8%, chronic osteomyelitis 7.3%, genu valgum 2.4%, and chondroblastoma 2.4%. The most frequently seen complications are nonunion of fractures, 36.6% of all cases as well as lower limb shortening, 29% of all complications. Others are ankylosis, malunion, delayed union, ulcers, contractures and gangrene. The difference in the number of complications and nonunion of fracture rate in the upper and lower limbs are insignificant, p CONCLUSION: Traditional bonesetters are patronized for musculoskeletal conditions other than injuries. Complications, sometimes severe, result from their treatment. These complications are largely preventable. Suggestions are made about reducing the number and patronage of the TBS and increasing utilization of modern orthopaedic service. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 112-115

Pattern of Motorcycle Accident-Associated Injuries in Port Harcourt – A Hospital-Based Study

Objective: To document some of the determinants and types of motorcycle-accident associated injuries in patients attending a private orthopaedic practice in Port Harcourt. Method: This is a 12 month prospective study starting March 2001. Relevant data was collected by the attending surgeon in a questionnaire previously prepared for the purpose. Frequency distribution tables were generated manually from this data. Results: One hundred and eighty six (186) road accident victims were seen out of which 47.3% were motorcycle accidents. The peak age of the victims was 20 – 39years and these made up 68.2% of the patients. The male/female ratio was 2:1. All 26 cyclists in the series were males; and pillion passengers were at the greatest risk of being injured. Most of the injuries occurred between Friday and Saturday (40.91%), and during the rainy season (47.7%). The largest proportion of the accidents occurred in the Diobu area Port Harcourt (28.4%). Most cases presented in the hospital immediately or after attention in other medical facilities (76.1%), while 23.9% sought traditional bonesetters' help before presenting. The latter group often presented as late as a week after the injury. Injuries to the extremities constituted the bulk of the injuries (54.3%). Motorcycle-car collisions were the commonest mechanism of injury (56.8%), while indirect or secondary injuries were commonest types (59.1%) of injuries. Conclusion: Motorcycle accidents cause a high proportion of road accident related injuries presenting to the Rehoboth Specialist Hospital, Port Harcourt. Recommendation: Safety precaution is still the gold standard for prevention of motorcycle accident related injuries. Key Words: Motorcycle, Cyclists, Pillion riders, Pedestrians Orient Journal of Medicine Vol.15(1&2) 2003: 36-40

Knowledge, Attitude and Practice about the Traditional Bone Setters among Health Workersi n Federal Medical Centre, Owo, Nigeria

The practice of traditional bone setters can no longer be denied in this environment as some of the complications resulting from their treatment are still seen commonly in orthopaedic surgical practice. This study was undertaken at the Federal Medical Centre, Owo, Ondo State, Nigeria to find out about knowledge, attitude and practice about the traditional bone setters (TBS) among health workers. A pre-tested questionnaire was distributed among the health workers through their heads of departments for ease of collection. The response rate was 88.2% with a male to female ratio of 1:1.7. 88.1% were aware of the TBS practice in our environment and 32.7% got to know about them through the mass media; constituting the greatest percentage proportion. Only 19.6% of the respondents claimed the knowledge of how traditional bone setters acquired their skills, 73.6% of these responded that it was innately acquired. While most of the respondents assessed their care as inadequate and that they should not be allowed to treat patients with fractures; 12.9% believed that the TBS possessed special powers to treat fractures that is lacking in orthopaedic surgeons. Health assistants were the most likely to be believe in the possession of such powers. It was recommended that the TBS should be banned from unvented access to the use of the mass media. Within the hospital environment, there is need to organize regular update or instructional lectures for health workers, especially the health assistants who are most likely to give wrong interpretations to events surrounding the patient treatment by the orthodox practitioners. (Key words: Chronic suppurative otitis media, Pseudomonas aerugi nosa, Hearing loss). Sahel Med. J. Vol.6(3) 2003: 79-82

Problems of amputation surgery in a developing country.

We studied prospectively 87 patients who underwent extremity amputation in the National Orthopaedic Hospital in Lagos in 1995-1996. Trauma from road traffic accident was the most common indication (34/87) with peripheral vascular disease being the least encountered (2/87). Traditional bonesetters' gangrene accounted for 9/87 cases in circumstances that were largely avoidable. Our study revealed that amputation is still being performed as a life-saving procedure, as 44/87 patients presented with gangrene of a limb. The nonavailability of special investigations such as Doppler ultrasound, arteriography, and CT scan was responsible for a delay in definitive treatment in 28 cases. Poor prosthetic services and the absence of a well-coordinated amputee clinic were responsible for some of the unsatisfactory results. We believe that the availability of specialized diagnostic tools and facilities for microvascular surgery, together with a multidisciplinary approach to the management of the amputee, would considerably change the current gloomy picture of amputation in developing countries such as Nigeria.

Erratum: Kap study about traditional bone-setters among health workers in owo, nigeria

Erratum: Kap study about traditional bone-setters among health workers in owo, nigeria

Bone setter's gangrene

Background/Purpose: Little published data exist on the morbidity and mortality associated with poor trauma care in developing countries. This report highlights our experience with iatrogenic limb gangrene related to fracture management by traditional bone setters. Methods: Children with “bone setter's” gangrene were identified from a prospectively recorded pediatric surgery database at the Royal Victoria Hospital in Banjul, The Gambia—the main government referral hospital. Results: Nine children were treated for bone setter's gangrene during a 29-month period. The average age was 8.2 years (range, 5 to 14 years). Bone setter's gangrene was more common in boys (male to female ratio, 2:1) and occurred almost exclusively (89%) in children from rural areas where access to health care was limited. Five children (56%) underwent proximal extremity amputations. Complications included 1 death related to sepsis, a case of chronic osteomyelitis at an amputation site, and a contracted insensate hand in a child whose parents refused amputation. Conclusions: Bonesetter's gangrene is a preventable complication that results from a failure of child health planners to recognize the importance of basic trauma care. Management of fractures should be considered an essential component of child health programs in developing countries. J Pediatr Surg 35:1431-1433. Copyright © 2000 by W.B. Saunders Company.

Major amputations in Nigeria: a plea to educate traditional bone setters.

A study was made of 100 major amputations performed on 96 patients in two regional hospitals in a 10-year period in Nigeria. The objective of the study was to evaluate the outcome of major amputations in Nigeria. The median age of patients was 30 years with male to female ratio 3:1. Ninety of the 100 major amputations involved the lower limbs with the above-the-knee/elbow-the-knee ratio of 0.5. Trauma was the leading indication for 70 amputations, of these 60 were iatrogenic resulting from mismanaged fractures by the traditional bone setters. The non-traumatic indications were: diabetic limb gangrene (20); bone malignancies (9); and vascular insufficiency (1). Provisional amputation was offered in 60 cases, of these 10 had reamputation. There were eight (8.5%) mortalities. The functional outcome for this group was discouraging. Only 25 amputees affording successful prosthetic fitting and social rehabilitation. Major amputation in Nigeria foreshadows a dismal existence and emphasizes the need for health policies which are effective in controlling the risk factors.

Traditional bone setter's gangrene.

Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.

Orthopaedic Surgeons

Bonesetting, a most ancient healing art, was absorbed into orthopaedic surgery approximately 120 years ago when Hugh Owen Thomas, a medical doctor specializing in pediatric deformities, assumed his father's nonmedical bonesetting practice. In many nonWestern nations, however, traditional bonesetters continue to treat large numbers of patients. Current market forces in the United States threaten to reduce the role of orthopaedic surgeons in the management of fractures not requiring surgery, leading to the possible reemergence of bonesetting as a separate and independent discipline.

Yoruba Traditional Bonesetters

Enquiries involving 165 Yoruba traditional healers revealed that the practice of surgery by these healers is rudimentary. Three traditional bonesetters were visited and interviewed extensively about their methods of diagnosis and treatment of fractures. Treatment sessions of one of the bonesetters were attended by the author and some aspects of his management were photographed. Case histories of two inpatients were recorded. The merits and demerits of the practice of traditional bonesetters are highlighted. Bonesetting as practiced by the Yoruba was compared and contrasted with similar treatment by other ethnic groups in Nigeria and with accounts available in the literature about other places like Liberia, Mali, East Africa, India, and China. The need to encourage Yoruba bonesetters to refer difficult cases to a modern hospital is stressed.

Traditional medicine and its practitioners among the yoruba of Nigeria: A classification

Nigeria, like many other developing countries, suffers from severe shortage of Western-trained health personnel. The only means of health care available to most of the 80% of her population who live in the rural areas are the traditional healers. Previous classification of Traditional healers among the Yoruba were critically reviewed. From information accruing from interviews of over fifty herbalists supplemented by the scanty information in the literature, a new and more comprehensive classification of Yoruba traditional healers was proposed. The criteria on which the classification was based were clearly stated. Seven categories of Yoruba Traditional healers were identified. These are the Babalawo; Onisegun (or Adahunse ); Alasotele (soothsayer); Olorisa (or Abore ); Awon 'leku-leja (traditional pharmacists); specialists comprising of traditional bone-setters, traditional psychiatrists, traditional birth attendants or midwives and the “Olola”; and a miscellaneous group consisting of Afaa (Mallams) and Aladura (spiritual healers). The functions of each category of traditional healers identified were clearly defined. The result of the study was discussed, with particular reference to the types of traditional healers found in other countries of the World where the role of traditional healers have been studied. The relevance of the present classification to the possible role of traditional healers in health-care delivery in Nigeria is highlighted.

Predisposing Factors and Outcome of Treatment of Non-Union of Long-Bone Fractures in Ibadan, Nigeria

This study was done to find out factors that contribute to development of Non-union of long bone fractures in this environment and the outcome of operative intervention. This is a prospective hospital based study. All patients with Non-union of long bone fracture that presented in the hospital since January 1997 were recruited into the study. The data included causative factors, treatment given before presenting in the hospital, type of surgical procedure and result of treatment. The study was completed in December, 2005. 78 patients presented with 87 Non-union of long bones. A male, female ratio of 1.6:1 was encountered while 69.2 per cent of the patients were below the age 55years. Road Traffic Accident accounted for 68 fractures (78.2 per cent) while duration of injury before presentation varies from 6 months to 22 months. Atrophic non-union occurred in 60 cases (69.0 per cent) and hypertrophic non-union in 21 cases. Non-union of the femur occurred in 33 cases (37.9 per cent) humerus in 24 cases (27.6 per cent), tibia in 16 cases (18.4 per cent), radius and ulna in 14 cases (16.1 per cent). The initial treatments of the fresh fracture in the 78 patients with nonunion were by the traditional bonesetters in 51 patients (65.4 per cent) while the remaining fractures were treated by plaster of paris in hospital. Open reduction and internal fixation using plate and screws with bone grafting was the most common procedure for treating the non-union in most cases. Union was achieved in the entire patients following surgical intervention. Important factor that appears to contribute to non-union of long bone in this environment is soft tissue interposition between the fracture ends of the bone, which is found in all fractures with more than one diameter displacement. Another factor is interference with periosteal blood supply from disruption of soft tissue envelope as a result of high energy injuries which is also responsible for the displacements that were observed in these fractures. The treatment by traditional bone setters which entails daily massage of the fracture creating a macro movement at the fracture site is also an important contributing factor.