American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Sciences and Medicine. 2020, 8(2), 62-70
DOI: 10.12691/ajmsm-8-2-4
Open AccessArticle

Traditional Bone Setter’s Gangrene of the Upper Extremity in Children: Experience from a Tertiary Health Institution

Richard C. Echem1, and Phillip D. Eyimina1

1Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Post code - 500001, Rivers State, Nigeria

Pub. Date: April 30, 2020

Cite this paper:
Richard C. Echem and Phillip D. Eyimina. Traditional Bone Setter’s Gangrene of the Upper Extremity in Children: Experience from a Tertiary Health Institution. American Journal of Medical Sciences and Medicine. 2020; 8(2):62-70. doi: 10.12691/ajmsm-8-2-4


Background: Traditional bone setting is an ancient healing art and is rife in sub-Saharan Africa. Traditional bone setter’s gangrene of the upper extremity in children is a serious complication of fracture care by traditional bone setters. Aim: To document upper extremity gangrene in children resulting from the practice of traditional bone setting as seen in a tertiary health institution. Methods: A prospective study of children presenting with upper extremity gangrene from the care of traditional bone setters at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018. Data obtained included the patients socio-demographics and relevant information related to the injury. Data was analysed with SPSS version 20. Results: Fifty-two children with upper extremity gangrene were seen. Their ages ranged from 1.5 to 14 years and most were males. Their parents mostly had primary and secondary levels of education and majority were married. The most common injury was humeral supracondylar fractures. These injuries were majorly from falls. Duration before presentation ranged from 2 to 5 weeks. Majority had massage, splinting and bandaging from the bone setter. Most common associated complication at presentation was sepsis. They all had provisional amputation. Most common amputation level was above elbow. The amputation stumps were refashioned from 5 to 35 days. Four had split skin grafting. Duration of hospital stay ranged from 9 to 108 days. There was no mortality. Conclusion: Upper extremity gangrene in children is a preventable sequelae of traditional bone setting. Parental health education is necessary to discourage their patronizing traditional bone setters.

traditional bone setters children upper extremity gangrene fracture management

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Green SA. Orthopaedic surgeons. Inheritors of tradition. Clin Orthop Relat Res 1999; (363): 258-263.
[2]  Agarwal A, Agarwal R. The practice and tradition of bonesetting. Educ Health (Abingdon) 2010; 23(1): 225.
[3]  Romer F. Remarks on manipulative surgery or bonesetting. Postgrad Med J 1926; 1(8): 110-115.
[4]  Kingston R. A tale of two bone-setters: an examination of the bone-setting tradition in Ireland. Beascna 2013; 8: 89-102.
[5]  Onuminya JE. The role of the traditional bonesetter in primary fracture care in Nigeria. S Afr Med J 2004; 94(8): 652-658.
[6]  Chowdhury MA, Khandker HH, Ahsan K, Mostafa DG. Complications of fracture treatment by traditional bone setters at Dinajpur. Dinajpur Med Coll J 2011; 4(1): 15-19.
[7]  Paul BD. The Maya bonesetter as sacred specialist. Ethnology 1976; 15: 77-81.
[8]  Adesina SA, Amole IO, Awotunde OT, Eyesan SU, Durodola AO, Adeniran A, et al. Family structure and bonesetter’s gangrene in children: a case series. Int J Trop Dis Health 2016; 14(2): 1-8.
[9]  Nwachukwu BU, Okwesili IC, Harris MB, Katz JN. Traditional bonesetters and contemporary orthopaedic fracture care in a developing nation: historical aspects, contemporary status and future directions. Open Orthop J 2011; 5: 20-26.
[10]  Thanni LO. Factors influencing patronage of traditional bone setters. West Afr J Med 2000; 19(3): 220-224.
[11]  Dada AA, Yinusa W, Giwa SO. Review of the practice of traditional bone setting in Nigeria. Afr Health Sci 2011; 11(2): 262-265.
[12]  Omololu AB, Ogunlade SO, Gopaldasani VK. The practice of traditional bonesetting: training algorithm. Clin Orthop Relat Res 2008; 466(10): 2392-2398.
[13]  Onuminya JE, Onabowale BO, Obekpa PO, Ihezue CH. Traditional bone setter’s gangrene. Int Orthop 1999; 23(2): 111-112.
[14]  Bickler SW, Sanno-Duanda B. Bone setter’s gangrene. J Pediatr Surg 2000; 35(10): 1431-1433.
[15]  Nwadiaro HC. Bone setters’ gangrene. Niger J Med 2007; 16(1): 8-10.
[16]  Eshete M. The prevention of traditional bone setter’s gangrene. J Bone Joint Surg Br 2005; 87(1): 102-103.
[17]  Ekere AU, Echem RC. Complications of fracture and dislocation treatment by traditional bone setters: a private practice experience. Niger Health J 2011; 11(4): 131-138.
[18]  Tekpa BJ, Ngongang OG, Keita K, Alumeti D, Sane AD, Dieme CB, et al. [Traditional bonesetter’s gangrene of limb in children in Regional Hospital of Kaolack (Senegal)]. Bull Soc Pathol Exot 2013; 106(2): 100-103.
[19]  Swann M, Walker GF. Amputations in developing countries. Br Med J 1966; 1(5494): 1041-1043.
[20]  Yakubu A, Muhammad I, Mabogunje O. Limb amputation in children in Zaria, Nigeria. Ann Trop Paediatr 1995; 15(2): 163-165.
[21]  Garba ES, Deshi PJ. Traditional bone setting: a risk factor in limb amputation. East Afr Med J 1998; 75(9): 553-555.
[22]  Ofiaeli RO. Complications of methods of fracture treatment used by traditional healers: a report of three cases necessitating amputation at Ihiala, Nigeria. Trop Doct 1991; 21(4): 182-183.
[23]  Agaja SB. Failures and complications of traditional bone setters treatment - case reports. Niger J Orthop Trauma 2005; 4(1&2): 84-95.
[24]  Solagberu BA. Long bone fractures treated by traditional bonesetters: a study of patients’ behaviour. Trop Doct 2005; 35(2): 106-108.
[25]  Thanni LO, Akindipe JA, Alausa OK. Pattern and outcome of treatment of musculoskeletal conditions by traditional bonesetters in South-West Nigeria. Niger J Orthop Trauma 2003; 2(2): 112-115.
[26]  Yinusa W, Ugbeye ME. Problems of amputation surgery in a developing country. Int Orthop 2003; 27(2): 121-124.
[27]  Onuminya JE, Obekpa PO, Ihezue HC, Ukegbu ND, Onabowale BO. Major amputations in Nigeria: a plea to educate traditional bone setters. Trop Doct 2000; 30(3): 133-135.
[28]  Umaru RH, Gali BM, Ali N. Role of inappropriate traditional splintage in limb amputation in Maiduguri, Nigeria. Ann Afr Med 2004; 3(3): 138-140.
[29]  Nwankwo OE, Katchy AU. Limb gangrene following treatment of limb injury by traditional bone setter (TBS): a report of 15 consecutive cases. Niger Postgrad Med J 2005; 12(1): 57-60.
[30]  Nwadiaro HC, Nwadiaro PO, Kidmas AT, Ozoilo KN. Outcome of traditional bone setting in the Middle belt of Nigeria. Niger J Surg Res 2006; 8(1-2): 44-48.
[31]  Omololu B, Ogunlade SO, Alonge TO. The complications seen from the treatment by traditional bonesetters. West Afr J Med 2002; 21(4): 335-337.
[32]  Alonge TO, Dongo AE, Nottidge TE, Omololu AB, Ogunlade SO. Traditional bonesetters in south western Nigeria- friends or foes? West Afr J Med 2004; 23(1): 81-84.
[33]  Akinyoola AL, Oginni LM, Adegbehingbe OO, Orimolade EA, Ogundele OJ. Causes of limb amputations in Nigerian children. West Afr J Med 2006; 25(4): 273-275.
[34]  Dada A, Giwa SO, Yinusa W, Ugbeye M, Gbadegesin S. Complications of treatment of musculoskeletal injuries by bone setters. West Afr J Med 2009; 28(1): 333-337.
[35]  Udosen AM, Ikpeme AI, Ngim NE. Traditional bone setting in Africa: counting the cost. Internet J Altern Med 2009; 7(2).
[36]  Oboirien M, Ismail S, Agbo PS. Paediatric amputations in Sokoto, north west Nigeria. Sahel Med J 2011; 14(1): 30-32.
[37]  Ajibade A, Akinniyi OT, Okoye CS. Indications and complications of major limb amputations in Kano, Nigeria. Ghana Med J 2013; 47(4): 185-188.
[38]  Onyemaechi NO, Onwuasoigwe O, Nwankwo OE. Complications of musculoskeletal injuries treated by traditional bonesetters in a developing country. Indian J Appl Res 2014; 4(3): 313-316.
[39]  Yusuf MB, Popoola SO, Oluwadiya KS, Ogunlusi JD, Ige OE. Management of complications of age-long tradition presented at Ado-Ekiti, southwest Nigeria. Afr J Trauma 2015; 4(1): 16-20.
[40]  Agu TC, Onyekwelu J. Traditional bone setters’ gangrene: an avoidable catastrophe, 8 years retrospective review in a private orthopaedic and trauma center in south-east Nigeria. Niger J Gen Pract 2016; 14(1): 1-5.
[41]  Omoke NI, Nwigwe CG. Limb amputations in Abakaliki, South East Nigeria. Afr J Med Health Sci 2016; 15(1): 30-35.
[42]  Nwosu C, Babalola MO, Ibrahim MH, Suleiman SI. Major limb amputations in a tertiary hospital in North Western Nigeria. Afr Health Sci 2017; 17(2): 508-512.
[43]  Odatuwa-Omagbemi DO, Akpojevwe E, Otene CI, Enemudo RE, Dioru UN, Obumse A. Left upper limb loss in a neonate from gangrene secondary to treatment of birth injury by traditional bone setters (TBS). IOSR J Dent Med Sci 2017; 16(5); 21-25.
[44]  Odatuwa-Omagbemi DO, Adiki TO, Elachi CI, Bafor A. Complications of traditional bone setters (TBS) treatment of musculoskeletal injuries: experience in a private setting in Warri, South-South Nigeria. Pan Afr Med J 2018; 30: 189.
[45]  Salawu ON, Babalola OM, Mejabi JO, Fadimu AA, Ahmed BA, Ibraheem GH, et al. Major extremity amputations: indications and post surgery challenges in a Nigeria tertiary institution. Sahel Med J 2019; 22(1): 8-12.
[46]  Loro A, Franceschi F, Dal Lago A. The reasons for amputations in children (0-18 years) in a developing country. Trop Doct 1994; 24(3): 99-102.
[47]  Kuubiere BC, Abass A, Mustapha I. Fracture complications after treatment by traditional bone setters in Northern Ghana. Adv Appl Sci Res 2013; 4(6): 207-211.
[48]  Kumma WP, Kabalo BY, Woticha EW. Complications of fracture treatment by traditional bone setters in Wolaita Sodo, southern Ethiopia. J Biol Agric Healthcare 2013; 3(12): 95-101.
[49]  Yasin S, Ayana B, Bezabih B, Wamisho B. Causes of pediatric limb amputations at Tikur Anbessa Specialized Hospital and the role of traditional bone setters (“Wogeshas”). Ethiop Med J 2018; 56(2). Available from: Accessed 10th June 2019.
[50]  El Hag MI, El Hag OB. Complications in fractures treated by traditional bonesetters in Khartoum, Sudan. Khartoum Med J 2010; 3(1): 410-405.
[51]  Doumi EBA, Osman AM, Hassan EM. Amputations of the upper limb in El Obeid Hospital, Western Sudan: role of traditional bone setters. Sudan Med J 2009; 45(2): 65-69.
[52]  Mathieu L, Bertani A, Chaudier P, Charpail C, Rongieras F, Chauvin F. Management of the complications of traditional bone setting for upper extremity fractures: the experiences of a French Forward Surgical Team in Chad. Chir Main 2014; 33(2): 137-143.
[53]  Dastgir N, Nabeel N, Butt KK. Musculoskeletal injuries by bone setters. Professional Med J 2012; 19(4): 446-448.
[54]  Alam W, Shah FA, Ahmed A, Ahmad S, Shah A. Traditional bonesetters; frequency of complications with treatment by traditional bonesetter. Professional Med J 2016; 23(6): 699-704.
[55]  Memon FA, Saeed G, Fazal B, Bhutto I, Laghari MA, Siddique KA,et al. Complications of fracture treatment by traditional bone setters in Hyderabad . J Pak Orthop Assoc 2009; 21(2): 58-64.
[56]  Khan I, Inam M, Saeed M, Afridi F, Arif M, Hakim A, et al. Complications of fracture treatment by traditional bonesetters. J Pak Orthop Assoc 2016; 28(1): 12-15.
[57]  Kunwar A, Chaudhary P. Clinico surgical profile of major limb amputations at tertiary care centre, Dharan, Nepal. J Community Health Manag 2015; 2(2): 68-71.
[58]  Warman PL, Ismiarto YD, Ruhimat U. Complications of fracture by traditional bonesetters in West Java, Indonesia. Althea Med J 2018; 5(1): 47-52.
[59]  Nazibullah M, Islam MT. Complications of fracture treatment by traditional bone setters at TMSS Medical College, Bogra. TMSS Med Coll J 2017; 9(2): 17-21.
[60]  Manjunatha V. Patronizing traditional bone setters and its complications - a study in Bangalore. IOSR J Dent Med Sci 2016; 15(6): 125-130.
[61]  Panigrahi TK, Mishra DN, Padhy N. Fracture management by traditional bonesetters: a hospital based observational study. J Med Sci Clin Res 2017; 5(10): 29177-29182.
[62]  Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ 2002; 80(10): 829-835.
[63]  Barlett SN. The problem of children’s injuries in low-income countries: a review. Health Policy Plan 2002; 17(1): 1-13.
[64]  Kibel SM, Bass DH, Cywes S. Five years’ experience of injured childen. S Afr Med J 1990; 78(7): 387-391.
[65]  Anjum R, Sharma V, Jindal R, Singh TP, Rathee N. Epidemiologic pattern of paediatric supracondylar fractures of humerus in a teaching hospital of rural India: a prospective study of 263 cases. Chin J Traumatol 2017; 20(3): 158-160.
[66]  Butt MF, Kawoosa AA, Dhar SA, Farooq M, Mir MR, Zargar HR. Outcome of treatment of the mismanaged pediatric elbow trauma: a series of 73 cases. Disabil Rehabil 2009; 31(5): 419-424.
[67]  Simmons D. Accidents in Malawi. Arch Dis Child 1985; 60(1): 64-66.