Complications of Musculoskeletal Injuries Treated by Traditional Bonesetters in a Developing Country

Introduction: Traditional bone setting is a well recognized and age long practice in Nigeria. This treatment often leads to severe complications. Aim of this study is to evaluate the complications seen in patients previously treated by traditional bonesetters (TBS) and to assess the reasons for the patronage and the factors that predispose to these complications. Materials and methods: This was a one-year prospective study involving 72 consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bonesetters. The data obtained using observer-administered questionnaires include: demography, details of initial injury, reasons for patronage of TBS, method of treatment by TBS, duration of the treatment, the mode of treatment, the number of TBS visited and the complications at presentation. Data were analyzed by SPSS (Version 17), P value < 0.05 was significant. Results: One hundred and eight complications from 93 musculoskeletal injuries were seen in 72 patients; 50 (69.4%) were male and 22 (30.6%) were female. The age range was 3 80 years (mean 36.8 years). The commonest complications were joint stiffness 29 (26.9%) and malunion 17 (15.7%). The major reasons for TBS patronage were advice of relatives and friends 25 (34.7%) and cheaper cost in 24 (33.3%) patients. The use of local splints was the commonest method of treatment, and the average duration of treatment was 94.5 days. Conclusion: TBS treatment is associated with severe complications. There was a significant association between the complications and the methods of treatment. Training and licensing of bonesetters may help to control this menace. Introduction In many developing countries, the traditional care of diseases and injuries remain popular among the citizens despite civilization and the existence of modern health care services (1, 2). In Nigeria, traditional bonesetters (TBS) are an integral part of trauma care. They perhaps more then any other group of traditional caregivers enjoy high patronage and confidence in the society. Their acceptance and patronage cut across social strata, educational qualification and religious beliefs. There is widespread belief in our society that TBS are better and treating musculoskeletal injuries than orthodox practitioners (2). The reasons for this include the belief that diseases and afflictions have spiritual components which cannot be treated by orthodox means. Many also consider TBS treatment to be cheaper (2-5) while others are afraid of operation or amputation at an orthodox hospital (6). In Nigeria, the TBS receive no formal training and practice without any form of license. Consequently, the outcome of their intervention in trauma care is characterized by complications, which include loss of limbs, life-long deformities and sometimes death. These complications pose a major challenge to Nigerian orthopaedic surgeons as they form a large number of cases seen by them and also create a lot of problems in terms of management (3-4). The treatment methods adopted by the TBS lack scientific basis which make limb and life threatening complications inevitable. Some of these dangerous practices include the use of tight local splints made of wood around fracture sites with consequent tourniquet effect and the use of excessive traction and massage at injury sites with attendant possibility of non-union and heterotopic calcification. Others are the use of local herbs and concoction in wound dressing which can cause infection and osteomyelitis and a virtually non-existent rehabilitation program. Previous studies (7, 8, 9) have reported various types of complications of musculoskeletal injuries treated by TBS, the reasons for the patronage and outcome of treatment of these complications. However, there is paucity of reports on the factors that predispose patients to these complications. The objective of the study is to evaluate the types of complications seen amongst patients whose injuries were previously treated by TBS, the reasons for TBS patronage and determine the factors that predispose to these complications. Material and Method: This was a prospective study of all patients with musculoskeletal injuries treated by the traditional bonesetters before presenting to the Accident and Emergency unit or the orthopaedic out-patient clinic of the Federal Medical Centre Makurdi (FMCM) North Central Nigeria.