Complication of Traditional Bone Settings: A Systematic Review

In many parts of the world, particularly across rural Africa and Asia, a person with a broken bone often turns first to a traditional bone setter. These practitioners are deeply respected members of their communities, often passing down their knowledge through generations. They use their hands to feel, manipulate, and massage injured limbs, sometimes applying herbal remedies or tight wooden splints to hold a broken bone in place while it heals. This approach is not merely a fallback for those without access to modern hospitals; for many, it is the primary, trusted, and culturally preferred way to treat musculoskeletal injuries. However, while the intention is healing, the methods used can sometimes lead to severe, unintended harm. The core question facing public health officials and medical researchers is not whether these practitioners exist, but what happens to the patients who rely on them when the treatment goes wrong.

A systematic review published by Fatihudeen Nafiu Okoro of Afe Babalola University brings together scattered evidence to answer this question with clarity. The study did not conduct new experiments or interview patients directly. Instead, the author gathered and analyzed twenty existing studies that had already been published in peer-reviewed journals. These original studies, conducted between 1986 and 2020, covered a total of 2,430 patients across low- and middle-income countries in Africa and Asia. The goal was to create a complete picture of the complications that arise when fractures and dislocations are treated by traditional bone setters rather than by modern medical professionals. By combining data from these diverse sources, the review moves beyond isolated anecdotes to reveal a consistent pattern of risk.

The findings are stark. Out of the thousands of patients reviewed, the researchers identified 1,101 distinct complication events. The most common problems were infections, where bacteria entered the wound, and osteomyelitis, a serious infection of the bone itself. In more severe cases, the lack of proper sterile techniques led to gangrene, a condition where body tissue dies due to a lack of blood supply, sometimes necessitating amputation. Beyond infection, the review highlighted orthopedic failures. Many bones healed in the wrong position, a condition known as mal-union, or failed to heal at all, known as non-union. These outcomes often resulted in permanent disability, chronic pain, or the loss of a limb. One study from Nigeria noted that in a specific group of patients treated by traditional bone setters, gangrene occurred in 100% of cases, with amputation required in sixty percent of those patients, while another study from Bangladesh found that mal-union occurred in eighty-three percent of patients treated by traditional setters.

The review also identified the specific actions that led to these dire outcomes. A major culprit was the use of tight, local splints made from wood or other materials. While intended to immobilize the bone, these splints were often applied too tightly, cutting off blood circulation to the limb. This lack of blood flow caused nerve damage, muscle death, and conditions like Volkmann's ischemic contracture, where the muscles permanently shorten and stiffen, locking the limb in a useless position. Another critical factor was the lack of sterile equipment. Without proper cleaning of tools or wounds, simple fractures became gateways for severe infections. The review suggests that many practitioners, despite their experience, lacked the scientific training to properly reduce a fracture—meaning to align the broken bone ends correctly—or to manage the healing process without causing further damage.

Despite these risks, the practice remains widespread. The review explains that patients do not choose traditional bone setting because they are unaware of modern medicine, but because of a complex mix of cultural trust, family influence, and economic necessity. In many rural areas, modern hospitals are far away or too expensive. Traditional bone setters are accessible, affordable, and embedded in the social fabric of the community. Patients often trust them more than distant doctors, believing that the traditional approach respects their cultural beliefs and offers a more holistic form of care. The review notes that this trust is reinforced by community networks; if a neighbor or family member was treated successfully, others will follow, even if the success rate is not statistically high.

The author concludes that the solution is not to ban traditional bone setting, which would likely drive the practice underground and leave vulnerable populations without any care. Instead, the review advocates for integration and education. It suggests that traditional practitioners should be trained in modern principles of fracture management, infection control, and patient safety. By teaching them how to apply splints correctly to avoid cutting off blood flow, how to recognize signs of infection, and when to refer a patient to a hospital, the health system could reduce the rate of complications significantly. The paper argues that policy makers must create regulations that standardize these practices, ensuring that the cultural value of traditional medicine is preserved while the safety of the patient is prioritized. The evidence is clear: without intervention, the gap between cultural tradition and medical safety will continue to cost people their limbs and their health.