Complications of Fracture and Dislocation Treatment By Traditional Bone Setters: A Private Practice Experience
Keywords:
Traditional bonesetters, Fractures, Dislocations, ComplicationsAbstract
Background: Traditional bone setting is common in developing nations. The principles of bone setting, although differing slightly among cultures are similar. The practice is not without its shortcomings as patients who have received prior traditional bonesetters (TBS) care usually present with complications to hospitals. This study seeks to document the complications seen as a result of TBS treatment of fractures and dislocations at a private ortho-trauma centre.
Methods : A prospective study of consecutive patients with fractures and dislocations who had received treatment from traditional bonesetters and were seen and managed afterwards at Rehoboth Specialist Hospital , Port Harcourt from 1st January 2007 to 31st December 2007 .
Results: During the study period, 71 patients were seen, consisting of 38 males and 33 females with a male to female ratio of 1.15:1. Their ages ranged from 4 years to 80 years with an average of 33.75 years. The most frequent age brackets were 20-29 years (32.39%) and 30-39 years (22.53%). Those with secondary and tertiary education constituted 81.69% of the total. More patients first consulted the TBS (63.38%) than orthodox practice (36.62%) after the injury. There were 74 fractures (86.05%) and 12 dislocations (13.95%) with more of the injuries occurring in the lower extremity. The most frequent aetiology was road traffic accidents, mostly motor-cycle related, followed by falls and sports injuries. Those who spent 4 months or more with the TBS before presentation constituted 69%. The most frequent complications were nonunion (36.47%) and malunion (24.71%) and both were associated with shortening in 31.76%. Other complications were chronic joint dislocation, ankylosis, joint stiffness, arthrosis/arthritis, chronic osteomyelitis, Volkmann's ischaemic contracture, osteonecrosis, neuropathy, limb gangrene, delayed union and pressure ulcer. The most frequent intervention was open reduction and internal fixation (60.56%) and most of the patients (78.87%) spent 4 weeks or less in the hospital. There was no mortality in this series.
Conclusion: Complications following treatment of fractures and dislocations by TBS are common. The common complications include non-union, malunion which were both associated with shortening as well as chronic joint dislocation, although the largely avoidable limb gangrene still occurred. There is a need for basic training of TBS for them to be integrated into the primary care system.
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