TMSS Medical College Journal

Background: Traditional bonesetters (TBS) practice widely in different parts of our country. Their treatment method often lead to several complications, most dangerous being extremity gangrene which usually leads to amputation. Our aim was to analyze the types of complications seen in patients previously treated by TBS and to assess factors that may predispose to the complications in Bogra District. Materials and Methods: We reviewed 98 cases from Jan 2015 — Jan 2017. There were 60 men and 38 women. All patients brought into the Hospital from Jan 2015 — Jan 2017 with fractures/traumatic injury who had been treated previously by bone setters and later on to us were included. Each patient was assessed and prescribed the most appropriate treatment for their fracture- reduction, immobilization (operatively and otherwise) and physiotherapy. Mal-union, non-union, delayed union, gangrene, stiffness of joints and loss of joint motion, Compartment syndrome, Volkmann's ischemic contracture. Result: Out of 98 patients, 10 patients (9.8%) had union of the fracture in acceptable position with near to normal range of movements at different joints and 88 (86.24%) out of 98 were having complications, 10 (14.7%) had mal-union (shortening and angulations), 5 (4.4 %) delayed union, 20(19.6%) had non union including 3 infected nonunion, & 5(4.9%) developed gangrene. 5 (4.9%) reported compartmental syndrome, 12 (10.56%) had extensive blister formation / cellulites, and 4 (3.52 %) had Volkmann’s ischemic contracture and rest of the patients had stiffness of elbow and shoulder. One third of the patients developed more than one complication. Conclusion: Traditional bone setting is an ancient trade practiced in most developing countries and also in Bangladesh without government regulations and they lack guidance. The result of this study indicates that treatment of musculoskeletal injuries by Traditional bone setters create very difficult problems in orthopedic practice. Many patients develop complications and loose their limbs due to inappropriate treatments. It is recommended that affordable and accessible hospital services, education of the bone setters, the public and the patients is necessary in minimizing or abolishing the preventable complications associated with traditional bone setting.

Traditional bonesetters (TBS) is an old practice established more or less in all societies of the world."? Up to 75% of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in our country. The traditional bone setter’s practice is a highly specialized form of traditional medicine. It is usually passed from father to son but some outsiders also receive their training via apprenticeship. In Bangladesh as in other parts of the developing world, there are traditional medicine practitioners. In one report from eastern Nigeria 85% of patients who presented with femoral fractures to an Orthopaedic Hospital had been to traditional bonesetters (TBS) prior to going to the hospital * There is widespread belief in our society that TBS are better at fracture treatment than orthodox practitioners. Little published data exist on the morbidity and mortality associated with poor trauma care in many of the developing countries especially in Bangladesh. This study was undertaken to evaluate prospectively the types of complications seen in patients previously treated by TBS and to assess factors that may predispose to these complications such as the type of bones fractured, the age of the patient and the duration of treatment by the TBS. This report highlights our experience with iatrogenic complications including limb gangrene related to fracture management by traditional bone setters.