The Impact Traditional Bone Setters Place on Operative Management of Femoral Fractures in JOS North Central Nigeria

Abstract

Background: Fracture of the femur occurs most times second only to tibio-fibula fracture. The patronage of traditional bone setters for the treatment of these fractures is still very high in our environment with an attendant unacceptable high complication rate. The aim of the study is to access critically the burden traditional bone setter management has on the outcome of operative treatment of femoral fractures Patients and Methods: The study was a four year retrospective review of patients who sustained closed isolated fracture managed operatively. Data were obtained using a profoma and analyzed using epi info. Results: A total of 99 patients were managed operatively for femoral fractures, with 55 males and 44 females having a male female ratio of 1.25:1. 43 of the patients were never managed by traditional bone setters (TBS) while the remaining patients were initially managed by TBS. The patients’ ages ranged from 15years to 80years, with a mean of 45.78±19.25. The mechanisms of injuries were: road traffic accidents 65.7%, fall from heights 17.2%, assaults, gunshot injuries 11.1%, fall from heights 2%. The fractures were anatomically located in the neck of femur 5.2%, shaft of femur 60.9%, trochanteric region 17.5%, subtrocahnteric 4.1% and femoral condyles 12.4%. The following procedures were carried out hemi-arthroplasties 6.2%, plate and screw 67.0%, interlocking nail fixation 13.4%, dynamic condylar screw 3.0% dynamic hip screw fixation12.4%. Estimated blood loss was 150mls-800mls for those that presented fresh and 100mls -2000mls for those that initially presented to tradition bone setters. The mean operative time in those that presented fresh was 55.40mins while for those that were initially managed by traditional bone setters was 108.46minutes. No fresh case had a significant residual limb length discrepancy post-surgery while 27.3% of those that presented to traditional bone setter had a post-operative limb length discrepancy. Conclusion: Patronage of traditional bone setters is still very high in this environment, and is associated an unnecessary high complication rate among the patients. These translate to increased post-operative morbidity and as such are an important preoperative consideration.