The role of the traditional bonesetter in primary fracture care in Nigeria.
BACKGROUND
In view of the growing interest in the management of fracture worldwide, the traditional bonesetter (TBS) practice in Nigeria was documented.


OBJECTIVE
To highlight the role of the TBS in primary fracture care in Nigeria.


METHODS
Rural.


METHODS
Over a 5-year period a qualitative study of the TBS settings and knowledge, diagnostic techniques and principles of fracture treatment in four TBS centres in Nigeria was carried out by active participation, on the spot assessment, interactive dialogues and oral interviews.


RESULTS
It was found that TBS services are well preserved as a family practice, and training is by apprenticeship. Records are kept by oral tradition. There is no prescribed fee and the patronage is high. Fracture diagnosis is based on physical assessment and experience. The TBS relies solely on the conservative method of fracture treatment, and all fractures are reduced by the closed method and stabilised with an external traditional splint and a protracted period of immobilisation. The outcome of TBS treatment is good for closed fractures of the shaft of the humerus, ulna, radius and tibia, but poor for peri-articular and open fractures. Non-union, malunion, traumatic osteomyelitis and limb gangrene were the common major complications of TBS treatment.


CONCLUSIONS
Despite criticisms and antagonism from orthodox medical practitioners TBS practice is well patronised by Nigerians. In order to guarantee safety and efficiency of the TBS practice in primary fracture care service delivery in Nigeria, there is therefore a need both to educate the community and to train the TBS.
Onuminya
J E
JE
Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, PMB 14, Ekpoma, Edo State, Nigeria.
D003906:Developing Countries; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000628:therapy*; D005596:Fractures, Closed / Q000628:therapy; D005597:Fractures, Open / Q000628:therapy; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D009549:Nigeria; D011203:Poverty; D018570:Risk Assessment; D012424:Rural Population