title: Management of the complications of traditional bone setting for upper extremity fractures: the experiences of a French Forward Surgical Team in Chad.
abstract: The practice of traditional bone setting (TBS) in sub-Saharan Africa often leads to severe complications after upper extremity fracture. The purpose of this study was to evaluate the management of these complications by a French Forward Surgical Team deployed in Chad. An observational, prospective study was conducted over a six-month period between 2010 and 2011. During this period 28 patients were included. There were 20 males and 8 females with a mean age of 30.6 years (range 5-65 years). Thirteen patients (47%) had mal-union of their fracture, nine had non-union (32%), three children (10.5%) presented gangrene and three patients (10.5%) suffered from other complications. Fifteen (54%) patients did not undergo a corrective procedure either because it was not indicated or because they declined. Only 13 (46%) patients were operated on. Twelve of these patients were reviewed with a mean follow-up of 2.4 months. All of them were satisfied with conventional treatment. The infection seemed to be under control in every septic patient. Bone union could not be evaluated in most patients because of the short follow-up. Management of TBS complications is always challenging, even in a deployed Western medical treatment facility. Surgical expectations should be low because of the severity of the sequelae and the uncertainty of patient follow-up. Prevention remains the best treatment.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Desgenettes Military Hospital, 108, boulevard Pinel, 69275 Lyon cedex 03, France. Electronic address: laurent.mathieu69@yahoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Mathieu
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Desgenettes Military Hospital, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
authors.forename: A
authors.initials: A
authors.lastname: Bertani
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Desgenettes Military Hospital, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
authors.forename: P
authors.initials: P
authors.lastname: Chaudier
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Laveran Military Hospital, 13384 Marseille cedex 13, France.
authors.forename: C
authors.initials: C
authors.lastname: Charpail
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Desgenettes Military Hospital, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
authors.forename: F
authors.initials: F
authors.lastname: Rongiéras
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Desgenettes Military Hospital, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
authors.forename: F
authors.initials: F
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002596:Chad; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications*; D017759:Fractures, Malunited / Q000209:etiology / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery*; D005602:France; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D008875:Middle Aged; D008952:Mobile Health Units; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D034941:Upper Extremity; D000078329:Workforce
keywords: Africa; Afrique; Chad; Fracture; Membre supérieur; Tchad; Traditional bone setting; Traitement traditionnel; Upper extremity