Risk Factors for Amputation and Prolonged Hospitalization Among Children Who Received Traditional Bonesetting in...

Area of Science:

• Orthopaedic surgery
• Global child health
• Ethiopian public health

Background:

• Limited access to formal orthopaedic services in Ethiopia leads to widespread use of traditional bonesetting (TBS).
• TBS is associated with severe complications, including limb-threatening and life-threatening outcomes in injured children.

Purpose of the Study:

• To identify risk factors for amputation in children treated with TBS.
• To determine risk factors for prolonged hospitalization (>7 days) in children treated with TBS.

Main Methods:

• Prospective enrollment of 460 children presenting to 8 Ethiopian hospitals after TBS over 15 months.
• Multivariable logistic regression analysis to assess associations between 16 covariates and outcomes (amputation, prolonged hospitalization).
• Covariates included demographics, injury characteristics, and TBS practices (topical treatments, immobilization).

Main Results:

• Amputation occurred in 5.7% and prolonged hospitalization in 22.2% of children.
• Risk factors for amputation included rural origin and non-osseous injuries.
• Rigid immobilization and organic topical TBS treatments significantly increased amputation odds.
• Older age and open fractures increased hospitalization odds, while higher parental education decreased it.

Conclusions:

• Rigid splinting and organic topical treatments used in traditional bonesetting are associated with increased risk of amputation and prolonged hospitalization in Ethiopian children.
• Training traditional bonesetters to abandon these harmful practices is crucial for preventing severe complications.