Peadiatric amputation from traditional bone setters’ gangrene in Ibadan: a malady

Mosimabale J. Balogun; Jemiludeen O. Morhason-Bello; Idowu K. Olusola

doi:10.18203/issn.2455-4510.IntJResOrthop20243105

Authors

Mosimabale J. Balogun Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
Jemiludeen O. Morhason-Bello Department of Orthopeadics and Trauma, University College Hospital, Ibadan, Oyo State, Nigeria
Idowu K. Olusola Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243105

Keywords:

Pediatric amputation, Traditional bone setters, Gangrene, Amputation, Surgical site infection, Rehabilitation

Abstract

Background: Pediatric amputations resulting from gangrene pose a significant medical challenge, especially in resource-limited settings. In Nigeria, traditional bone setters (TBS) often serve as the first point of contact for musculoskeletal injuries, but their practices can lead to severe complications, including gangrene. Our hospital manages many of such cases. This study aims to explore the epidemiology, clinical presentation, and outcomes of pediatric patients who developed gangrene requiring amputation following TBS treatment, with the goal of informing public health strategies and improving pediatric care quality.

Methods: The study is a retrospective study which seek to extract the data from the hospital record all the patient who underwent amputation due to gangrene after initial TBS treatment. All the case notes were retrieved and data was extracted and analyzed using descriptive statistics. The study adhered to ethical standards and anonymized data to protect patient confidentiality, ensuring the study's integrity.

Results: The study involved 33 pediatric patients aged 8.3 years, with a significant gender disparity. Most patients were from the Yoruba ethnic group and practiced Islam. 87.9% of parents had no formal education. Gangrene was most common in the left hand, and falls were the leading cause of initial injury. The average surgery time was 81.2 minutes, with a 13-day hospital stay. Post-operative complications occurred in 43.5% of patients, with surgical site infections (SSI) being the most common. Only 8.7% received occupational therapy.

Conclusions: The study highlights post-operative care challenges in pediatric amputations, including high complications and limited access to services. It suggests targeted interventions, infection control, and public health campaigns to improve outcomes. Future research should include long-term follow-up studies.

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References

Bhargava A, Mahakalkar C, Kshirsagar S. Understanding Gangrene in the Context of Peripheral Vascular Disease: Prevalence, Etiology, and Considerations for Amputation-Level Determination. Cureus. 2023;15(11):e49026.

Omololu AB, Ogunlade SO, Gopaldasani VK. The practice of traditional bonesetting: Training algorithm. Clin Orthop Relat Res. 2008;466(10):2392-8.

Chika A, Onyekwelu J. Traditional bone setters′ gangrene: An avoidable catastrophe, 8 years retrospective review in a private orthopedic and trauma center in South-East Nigeria. Nigerian J General Pract. 2016;14(1):1.

Joseph Sina O, Taiwo OC, Michael Ayodele I. Traditional Bone-Setters and Fracture Care in Nigeria. Merit Res J Art Social Sci Humanities. 2014;2(6):74-80.

Biddle SJH, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci. 2004;22(8):679-701.

Deji-Dada OO, Dada SA, Ogunlusi JD, Solomon OA. Patients’ satisfaction with emergency care services in a University Teaching Hospital in South-West, Nigeria. African J Emergency Med. 2021;11(2):321-4.

Factors influencing patronage of traditional bone setters. Available at: https://www.researchgate.net/ publication/12202987_Factors_influencing_patronage_of_traditional_bone_setters. Accessed on 25 August 2024.

Onyemaechi NOC, Lasebikan OA, Elachi IC, Popoola SO, Oluwadiya KS. Patronage of traditional bonesetters in Makurdi, north-central Nigeria. Patient Prefer Adherence. 2015;9:275-9.

Richards O, Cheema Y, Gwilym B, Ambler GK, Twine CP, Bosanquet DC. Clinical Effects of Tourniquet Use for Nontraumatic Major Lower Limb Amputation: A Two-Center Retrospective Cohort Study. Ann Vasc Surg. 2024;104:53-62.

Choksy SA, Lee Chong P, Smith C, Ireland M, Beard J. A Randomised Controlled Trial of the Use of a Tourniquet to Reduce Blood Loss During Transtibial Amputation for Peripheral Arterial Disease. Eur J Vascular Endovascular Surg. 2006;31(6):646-50.

Gosselin RA, Thind A, Bellardinelli A. Cost/DALY Averted in a Small Hospital in Sierra Leone: What Is the Relative Contribution of Different Services? World J Surg. 2005;30(4):505-11.

Ortopedik Travma Asistan El Kitabı. Available at: https://www.nobelkitabevi.com.tr/ortopedi-ve-travmatoloji-/20286-ortopedik-travma-asistan-el-kitabi-9786257354820.html. Accessed on 25 August 2024.

Psychological Adaptation to Amputation | O and P Virtual Library. Available at: https://www.oandp library.org/alp/chap28-01.asp. Accessed on 25 August 2024.

Traditional Bone Setting in Nigeria: Issues and Challenges. Available at: https://www.research gate.net/publication/364815634Traditional_Bone_Setting_in_Nigeria_Issues_and_Challenges. Accessed on 25 August 2024.

Edelstein JE, Denninger SA. Rehabilitation for children with limb deficiencies. Orthotics Prosthetics in Rehabilitation. 2019;738-58.