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Risk Factors for Amputation and Prolonged Hospitalization Among Children Who Received Traditional Bonesetting in
Ephrem G Adem1, Papa K Morgan-Asiedu2,3, Mengistu G Mengesha1
1Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.
Insights
Traditional bonesetting (TBS) in Ethiopian children is linked to higher amputation and hospitalization risks. Rigid immobilization and organic topical treatments during TBS significantly increase these dangers, highlighting the need for bonesetter training.
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.
Background:
In Ethiopia, orthopaedic services are limited, and many injured children undergo traditional bonesetting (TBS) despite its association with limb- and life-threatening complications. We sought to identify the risk factors for amputation and a prolonged hospitalization of >7 days in children who presented to hospitals after undergoing TBS.
Methods:
Over a 15-month period, we prospectively enrolled children who presented to 8 Ethiopian hospitals after undergoing TBS. Separately for each outcome (amputation and prolonged hospitalization), we used multivariable logistic regression to evaluate associations between the outcome and 16 covariates, including demographic and injury characteristics, parent or guardian preference for TBS, and TBS topical treatments and immobilization methods.
Results:
We enrolled 460 children (mean age, 9.0 ± 4.0 years; 75% male) representing 8 Ethiopian regions and diverse demographic and socioeconomic backgrounds. Elbow injuries (194 patients; 42.2%) and closed fractures and/or dislocations (364 patients; 79.1%) were most common. TBS treatments included topical inorganic (190 patients; 41.3%) or organic (82 patients; 17.8%) material application and rigid (166 patients; 36.1%) or soft (182 patients; 39.6%) immobilization. Twenty-six children (5.7%) underwent an amputation, and 102 (22.2%) had a prolonged hospitalization. The odds of amputation were higher for children from rural communities (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 2.01 to 22.41) and for children with only non-osseous injuries (AOR, 5.76; 95% CI, 1.56 to 21.28). The odds of prolonged hospitalization were higher for children who were 11 to 17 years old (AOR, 2.77; 95% CI, 1.18 to 6.50) and for children with open fractures with a grade of ≥2 (AOR, 4.52; 95% CI, 1.33 to 15.28) but were lower for children from households with secondary education or higher (AOR, 0.40; 95% CI, 0.21 to 0.79). TBS with rigid immobilization increased the odds of amputation (AOR, 5.84; 95% CI, 1.74 to 19.60) and prolonged hospitalization (AOR, 2.20; 95% CI, 1.02 to 4.73). TBS organic topical treatment (with mud, leaves, or butter) increased the odds of amputation (AOR, 3.88; 95% CI, 1.40 to 10.73).
Conclusions:
For children who underwent TBS prior to hospital presentation, rigid splinting by bonesetters increased the odds of amputation and prolonged hospitalization. TBS organic topical treatments also increased the odds of amputation. Training bonesetters to avoid these dangerous practices may prevent devastating complications for children in Ethiopia.
Level Of Evidence:
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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