Reasons for seeking treatment and complications of fractures and dislocations among patients from bonesetters seen in mulago hospital.

Abstract

INTRODUCTION: Traditional bonesetters participate in the management of fractures and dislocations in most communities in Uganda. The practice is occasioned by complications. This study was carried out to establish reasons for seeking treatment from TBS, and describe complications of fractures and dislocations among patients from TBS seen in mulago hospital. It was aimed at generating vital information that will be of use in health education of the public on complications that may arise from management of fractures and dislocations by bonesetters. METHODS: This was a cross sectional-descriptive study, conducted in the orthopaedic surgical outpatient clinic, Assessment centre, general orthopaedic wards and A and E Department of mulago hospital from 1st December 2007-30th April 2008. Seventy one patients who had been to bonesetters were studied. A full clinical history, physical examination and radiographs for radiological diagnosis were done. Information was entered on data collection tool and analyzed using descriptive and inferential statistics. RESULTS AND CONCLUSION: Out of 71 patients who had been to TBS , 17 (23.9%) patients had been admitted in hospital before they escaped to bonesetters. Twenty five (35.2%) were females, 46(64.8%) males, and F:M=1:1.84. The age range was 4-77 years, with the mean age at 27.4 years. The majority of patients (80.3%) were 40 years and below. Thirty eight (53.5%) patients were from urban and 33 (46.5%) rural areas. The highest level of formal education among the study patients was university education. The reasons for seeking treatment from bonesetters included, dogmatic belief that TBs cause bones to unite 30(42.25%), services were cheap 11(22.5%), services were convenient 16(22.5%), seen patients seen successfully 29(40.8%), fear of amputation in hospitals 8(11.26), fear of POP cast 3(4.22%) TBS services were reliable 12(16.01%), could achieve faster bone union 4(%>^£%) conviced by friends or relatives 4(5.63%), and others 4(5.63%). The reasons were based on beliefs rather than access to orthopaedic services or level of education. The decisions were statistically not significant based on p_value 96.4 and x2.733. The reasons given for seeking treatment from the bonesetters and that given by patients for escaping from the hospital were statistically significant. Sixty three point four percent (63.4%) of the patients had complications of fractures; Non union were 23 (34.8%) Malunion 22(33.3%) Osteomyelitis 6(9.1%) Gangrene of forearm 2(3.0%) Septic ulcer 2(3.0%) Painful swollen fractured limb following TBS manipulation 8(12.1%) Tetanus 1(1.53%) And 1(1.53%) patients had both motor and sensory loss of the whole right upper limb. There was no patient who had had epiphyseal injuries. Patient with unreduced dislocations were 14(19.7%), and fracture dislocations 5(6.9%). Most complications were associated with muscle wasting and joint stiffness. It is therefore recommended that addressing the above reasons during health education of the public be instituted to reduce the morbidity arising from such treatment.