Traditional Bonesetters and Contemporary Orthopaedic Fracture Care in a Developing Nation: Historical Aspects, Contemporary Status and Future Directions

In developing nations such as Nigeria, where there is a shortage of surgeons formally trained in fracture care, many of the injured seek care from traditional bonesetters. We conducted a qualitative study of fracture care in two settings in Enugu, Nigeria: The National Orthopaedic Hospital Enugu (NOHE) and a traditional bonesetter practice. Primary assessment measures at the NOHE included evaluations of the structure and process of fracture care according to the Orthopaedic Trauma Association's Level 1 Trauma Center Requirements. Further, we conducted interviews of NOHE patients and hospital staff. We also observed fracture care at a traditional bonesetter practice. We observed the traditional care process and interviewed both bonesetters and patrons of the bonesetter practice.Although the NOHE does not qualify for certification as a Level 1 Trauma Center; the hospital does provide quality care. Our observations suggest a tension between Western and indigenous musculoskeletal practices. We propose that bonesetters not only be taught certain injury management techniques but also be incorporated into the Nigerian healthcare scheme. Bonesetters fill a void created by the severe lack of surgeons and further; bonesetters are primarily located in rural areas where they best care for underserved communities. In an integrated scheme, bonesetters would manage fractures for which they can achieve acceptable outcomes, referring others to local hospitals. An integrated model of fracture care is applicable in all developing countries where bonesetters perform a large proportion of fracture care.