Systematic review of complications associated with treatment by traditional bone setters for musculoskeletal injury

Abstract

In order to synthesise the existing evidence of Traditional Bone Setters' (TBS) treatment and its associated complications in Low and Middle Income Countries (LMICs), we conducted a literature search following PRISMA guidelines. The keywords “traditional bone setter”, “traditional bone healer”, “traditional bone setting”, “fracture”, “complication”, “low income country”,” low to middle income country”, “poor outcome” and “death” were searched in PubMed. Articles included in the review demonstrated complications associated with treatment by TBS for Musculoskeletal injury in LMICs. Out of 878 papers screened, twelve studies were finally included for review. Seven were prospective, and five retrospective studies. All were observational studies with all but one hospital based, the remaining being community based, and investigated the outcomes of treatment of fractures by traditional bonesetters published between 1999 and 2020 in LMICs. In total, this review covers 833 participants with 691 complications of TBS treatment. We identify a significant number of limb and life-threatening complications including mortality associated with the treatment by TBS. However, recent studies have shown that TBS are willing and keen to engage with local orthodox services and training courses. As shown in many countries, this can lead to a reduction in complications including mortality and can form a favourable environment where TBS and orthodox services can work side by side.

Improving the management of open tibia fractures, Malawi

“…Additionally in some countries, particularly in the Saharan belt, training of traditional bone setters might help reduce complications of open fracture care. 45 …”

Commonalities and differences in injured patient experiences of accessing and receiving quality injury care: a qualitative study in three sub-Saharan African countries

“…For instance, recent research indicates that traditional bone setters are receptive to engagement with orthopaedic services, offering opportunities to mitigate complications through joint management approaches. 27 One potential avenue for enhancing access to quality injury care could involve integrating rehabilitative physiotherapy services into bone-setting centres, fostering synergistic partnerships for improved patient outcomes.…”

Frequency of Complications among Trauma Patients Treated by Traditional Bone Setters Presented to Orthopedics Department, Gujranwala Teaching Hospital Gujranwala.

“…In developing countries, a significant portion of fracture treatments is administered by traditional bone setters (TBS), also known as quacks, who lack formal medical training and knowledge (1). TBS are typically lay practitioners skilled in joint manipulation, engaging in the healing and realignment of bones without any formal education in recognized medical procedures (2).…”