Aims and Objectives:The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS.Materials and Methods:A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS’ treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment.Data Analysis:Analysis was done with SPSS software Version 20.Results:A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1.Conclusions and Recommendations:With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.

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Talipes equinovarus (Clubfoot) is the commonest foot deformity with variable incidence across races. Exact etiology remains elusive. The objective of this study is to describe the epidemiology of clubfoot in our centre, looking for predisposing factors. This is a descriptive clinic based epidemiologic study of 106 feet belonging to 69 subjects from January 2014 -December 2015 was conducted. Structured questionnaires were administered to clinically confirmed clubfoot subject's guardian or biologic mothers. Phenotypic data from clubfoot subject were also recorded. Analysis was done using IBM SPSS version 22 for windows. Results revealed the age range of the patients as 3 days to 9 years, with a mean age of 46.17 ± 92.03 weeks. Thirty-seven (53.7%) patients had bilateral deformity while 13 (18.8%) patients had right-sided deformity, and 19 (27.5%) patients had left-sided deformity. Majority 40 (58.0%) of the patients were firstborn out of which 28 were males. Only 2 (2.89%) patients are products of multiple gestations. All mothers were none smokers and there was no reported family history of foot deformities or clubfoot. The mean maternal age was 25.81 years ± 4.99 years. The average length/height of patients at presentation was 64.27 ± 23.93 cm. The average shoulder span of the patients at presentation was 23.93 ± 15.86 cm. The study thus revealed that young maternal age, gender and firstborn are predisposing factors in the etiology of clubfoot.

Osteomyelitis of the navicular bone is not common; the few reported cases are haematogenous osteomyelitis of the navicular bone and were mostly seen in children and another case seen in an adult. We are presenting a case of domestic accident resulting in chronic osteomyelitis of the navicular bone in an adult caused by direct inoculation of infection following traditional bone setter’s mismanagement and subsequent surgery on the same foot. Consent is duly obtained from the patient to present this case report. The aim of this case presentation is to highlight the need for high index of suspicion of osteomyelitis of the bones of the foot in adult which are not necessarily secondary to haematogenous spread as seen in children but due to direct inoculation of micro- organisms, the study also seeks to demonstrate a complete cure of chronic osteomyelitis following proper debridement of the sequestrum with adequate use of the relevant antibiotics for the specified durations of administration. The patronage of traditional bone setters by most patients in Africa is still worrisome because this results in delayed presentation and attendant complications as seen in this index patient. In conclusion, chronic osteomyelitis of navicular in adults tend to follow direct inoculation of micro-organism but with a radical debridement with appropriate administration of antibiotics can result in cure. However, health education is necessary to discourage patients’ patronage of traditional bone setters and encouraging early presentation with good outcomes.

Purpose: Open reduction and internal fixation of fractures is surgical procedure guided by standard principles and often performed by Orthopaedic specialists. Unfortunately, some quacks now dabble into performing these complex procedures resulting in several complications. However, it has becoming a serious public health concern in that a traditional bone setter in collaboration with some health workers (quacks who were community health extension workers) engaged in performing an open reduction and internal fixation for a femoral fracture in our index patient with very severe complications. Methodology: We present this case of open reduction and internal fixation by traditional bone setters and quacks to illustrate the extent of malpractices by traditional bone setters aided by quacks who have either been assisting Orthopaedic surgeons in the theatre or have been watching these procedures as they are frequently been carried out in the operating room. Results: This index patient, a university undergraduate presented via our outpatient clinic having been mismanaged by a traditional bone setter in collaboration with a Community health extension work. An informed consent was duly taken from the patient concerning the reporting of the case and he was fully clerked, investigated and managed until he left against medical advised due to financial constraints. Unique contribution  to  theory,  practice  and  policy: We strongly recommend legislation and enforcement of laws that restrict traditional bone setters to limit their practices within their capacities under supervision if they must be allowed for any reason to practice management of simple fractures. The Community Health Extension Workers(CHEW) are to be under strict regulation by the Medical councils to prevent this unwholesome practices.