Role of Traditional Bone Setters in Africa: Experience in Calabar, Nigeria

Background: It is a known fact that majority of bony injuries in our society are treated by traditional methods. Even the elite often-times shows evidence of doubt in the efficacy of orthodox methods of bone treatment. Method: Interviews using questionnaires were administered to owners of traditional bone centres and their clients respectively. Eight (8) of such centres were visited in Calabar and their environs. Results: Results showed that all the practitioners had little or no formal education. All of them claimed ancestral/supernatural inheritance of the trade and do not want to disclose any secret. There was complete lack of knowledge of anatomy, physiology and the sources of complications. They lack basic knowledge of investigations and wound care. Most of the clients found themselves at the Traditional bone centres (TBC) because of poverty, ignorance and superstitious beliefs. The traditional bone setters (TBS) do record some success in simple fractures and dislocations but all of them see orthodox bone treatment as rivalry. Conclusion: It may be difficult to stop traditional bone setting in our society but may be easy to stop the complications by drawing the TBS together for the purpose of basic education and restriction. Training of more specialists in the area of Orthopaedics and Traumatology and provision of adequate basic equipment/appliances in our health institutions may reduce the rate of "Leaving hospital to the Traditional bone centres against medical advice".Introduction : c'est connu par tous que la majorit\ue9' des fractures d'os sont traites de mani\ue8re traditionnelle dans notre soci\ue9t\ue9. M\ueame nos \ue9lites ont le plus souvent montre certaines \ue9vidences de doute concernant l'efficacit\ue9 des mani\ue8res orthodoxe utilis\ue9es pour ce genre de traitement. M\ue9thode : Les interviews utilisant des questionnaires ont \ue9t\ue9 effectues `a l'encontre des propri\ue9taires et pratiquants de l'orthop\ue9die traditionnelle et ainsi qu `a leurs clients. Entour 8 (huit) de ces contres ont \ue9t\ue9 visites `\ue0 Calabar et ses environs. R\ue9sultat: Les r\ue9sultats ont montres que aucun ou tr\ue8s peut sont \ue9duques. Tous soutiennent une h\ue9ritage ancestrale ou de fer ce super naturel guidant cette pratique et ne veulent en aucun cas en r\ue9v\ue9ler le secret. Mous avions eu a observer une manque total de connaissance en anatomie, physiologie d`ou la source des complications qui en d\ue9coule, g\ue9s manquent de notions \ue9l\ue9mentaires pour diagnostiqu\ue9 et traitement des plaies. La plus part de leurs clients y viennent a cause de la pauvret\ue9, l'ignorance et les croyances superstitieusement. L'orthop\ue9die traditionnelle enregistre certains succ\ue8s dans le traitement des fractures simples et dislocations, mais tous voyons cette pratique comme rival a l'orthop\ue9die moderne. Conclusion : Nous voyons qu'il est n\ue9cessaire de rapprocher les praticiens de l'orthop\ue9die traditionnel ensemble pour le besoin de leurs pratiques une \ue9ducation \ue9l\ue9mentaire. Voir restreindre leurs pratiques si nous tenons \ue0 revoir en baisse le taux de complication survenait de leur pratique. La formation de plusieurs sp\ue9cialiste en domaine d'orthop\ue9die et traumatologie, et aussi l'approvisionnement en \ue9quipement \ue9l\ue9mentaire et ad\ue9quate pour diagnostiqu\ue9 dans nos contres de sont pourront redire consid\ue9rablement \uabl'abandons des hospitalit\ue9 en gaveur des tradi-practicients malgr\ue9' leur contre indication promulgue' par les conseilles m\ue9dicaux\ubb

Chronic Wounds in Children: Prevalence, Aetiological Types and Predilection Sites in a Rural Setting in an Emerging Economy

The aim of this study was to determine the prevalence, aetiological types and predilection sites of chronic wounds in children. This study was a cross sectional study conducted on children aged 0-15 years. Through cluster sampling technique, children with wounds were recruited and evaluated. Demographic and clinical data were collected and analyzed. Descriptive statistics were used to summarize variables and Chi-squared test was used to achieve comparison between age groups and sexes. Statistical significance was defined as p<0.05. The results show that one thousand and ten children were screened for wounds out of which 107 children with 115 wounds were found. 16.5% of these wounds were chronic with a prevalence rate of 2.0%. Chronic wound prevalences in the school aged (47.4%) and adolescent (52.6%) children were 0.9% and 1.0% respectively (x2 = 0.821; p = 0.359 Yates’ corrected, Fisher’s exact test 2-sided) and statistically insignificant. 57.9% were caused by trauma and majority (89.5%) occurred in the lower limbs (x2=0.000; p=1.000 Yates’ corrected, Fisher’s exact test 2-sided) without any statistical significance. Prevalence of chronic wounds in the children population was very low. The commonest aetiological type was inadequately treated traumatic wounds which progressively healed on institution of appropriate wound treatment

Augmented Adipofascial Flap for Soft Tissue Cover of Open Tibial Fractures : A Case Report

This is the management of a 30-year-old male student, a passenger on anbsp motor cycle who had an open tibial fracture. He was resuscitated by the Accident and Emergency doctors before the Orthopeadic and Plastic surgery units were invited to take over the management. The fracture was reduced and maintained with external fixators by the Orthopeadic surgeons and an augmented fascial flap and a split thickness skin graft were used to cover the fracture by the plastic surgical team. The wounds healednbsp in three weeks and thenbsp fracture united in four months

Microbial Spectrum and Antibiogram of Non-surgical Wounds in Children in a Rural Setting in Nigeria

The aim of this study was to determine the microbial spectrum and susceptibility pattern of non-surgical wound infections in children in a rural setting in our environment. This study was a cross sectional study of children aged 0 to 15 years in Bakassi, Nigeria. The children were screened for non-surgical wounds using an interviewer administered semi-structured questionnaire. Identified wounds were evaluated clinically for signs of infection and specimens were collected and cultured using standard microbiologic techniques. Susceptibility test was performed on all the isolated Micro-organisms. Data were collected and analysed using SPSS version 20 for windows. Sixty four wound infections out of a total of 115 wounds giving an infection rate of 55.7% were encountered. Of 64 wound cultures, 46.9% (30/64,) yielded mono-microbial growth, while poly-microbial growth of two and three microorganisms were obtained in 46.9% (30/64) and 1.6% (1/64) specimens respectively.A total of 92 organisms were isolated belonging to seven different species. Staphylococcus aureus (n= 57/92, 62.0%) and Streptococcus pyogenes (n = 30/92, 32.6%) were the predominant pathogens isolated. High rate of community acquired Methicillin Resistant Staphylococcus aureus (MRSA) (38/57, 66.7%) was observed. The microbial spectrum of non-surgical wounds of children in rural communities is wide. The high rate of antimicrobial resistance particularly MRSA and high predominance of S. pyogenes are potential sources of dire consequence in management and long term morbidity

Role of Traditional Bone Setters in Africa: Experience in Calabar, Nigeria

Background: It is a known fact that majority of bony injuries in our society are treated by traditional methods. Even the elite often-times shows evidence of doubt in the efficacy of orthodox methods of bone treatment. Method: Interviews using questionnaires were administered to owners of traditional bone centres and their clients respectively. Eight (8) of such centres were visited in Calabar and their environs. Results: Results showed that all the practitioners had little or no formal education. All of them claimed ancestral/supernatural inheritance of the trade and do not want to disclose any secret. There was complete lack of knowledge of anatomy, physiology and the sources of complications. They lack basic knowledge of investigations and wound care. Most of the clients found themselves at the Traditional bone centres (TBC) because of poverty, ignorance and superstitious beliefs. The traditional bone setters (TBS) do record some success in simple fractures and dislocations but all of them see orthodox bone treatment as rivalry. Conclusion: It may be difficult to stop traditional bone setting in our society but may be easy to stop the complications by drawing the TBS together for the purpose of basic education and restriction. Training of more specialists in the area of Orthopaedics and Traumatology and provision of adequate basic equipment/appliances in our health institutions may reduce the rate of "Leaving hospital to the Traditional bone centres against medical advice".Introduction : c'est connu par tous que la majorité' des fractures d'os sont traites de manière traditionnelle dans notre société. Même nos élites ont le plus souvent montre certaines évidences de doute concernant l'efficacité des manières orthodoxe utilisées pour ce genre de traitement. Méthode : Les interviews utilisant des questionnaires ont été effectues `a l'encontre des propriétaires et pratiquants de l'orthopédie traditionnelle et ainsi qu `a leurs clients. Entour 8 (huit) de ces contres ont été visites `à Calabar et ses environs. Résultat: Les résultats ont montres que aucun ou très peut sont éduques. Tous soutiennent une héritage ancestrale ou de fer ce super naturel guidant cette pratique et ne veulent en aucun cas en révéler le secret. Mous avions eu a observer une manque total de connaissance en anatomie, physiologie d`ou la source des complications qui en découle, gés manquent de notions élémentaires pour diagnostiqué et traitement des plaies. La plus part de leurs clients y viennent a cause de la pauvreté, l'ignorance et les croyances superstitieusement. L'orthopédie traditionnelle enregistre certains succès dans le traitement des fractures simples et dislocations, mais tous voyons cette pratique comme rival a l'orthopédie moderne. Conclusion : Nous voyons qu'il est nécessaire de rapprocher les praticiens de l'orthopédie traditionnel ensemble pour le besoin de leurs pratiques une éducation élémentaire. Voir restreindre leurs pratiques si nous tenons à revoir en baisse le taux de complication survenait de leur pratique. La formation de plusieurs spécialiste en domaine d'orthopédie et traumatologie, et aussi l'approvisionnement en équipement élémentaire et adéquate pour diagnostiqué dans nos contres de sont pourront redire considérablement «l'abandons des hospitalité en gaveur des tradi-practicients malgré' leur contre indication promulgue' par les conseilles médicaux»

Tourniquet Injuries In Hand Surgery: Prevention And Management In University of Calabar Teaching Hospital

Background: Tourniquet is commonly used in hand surgery to provide bloodless field that will facilitate dissection although fraught with complications. Aims: This study is aimed at identifying complications associated with the use of tourniquet in our practice as well as their prevention and management. Materials and Methods: Our cohort included 152 patients who underwent one of the most common procedures in the unit for hand trauma or infection, tumours including ganglion, syndactyly, trigger finger and camptodactyly with an average follow up period of 8 months. Exclusion criteria included incomplete notes, no documented post operative follow- up, pre-existing soft tissue damage or neurological lesion affecting the limb concerned. 25 patients were excluded because of incomplete or missing notes, 4 no follow-up records and 2 pre-existing nerve or soft tissue injury in the affected hand. Medical notes relating to the cohort were documented, the type of procedures, tourniquet time, adequacy of the bloodless field using the quantity of the estimated blood loss and any intra-operative or post-operative complications were also ascertained.Results: 121 patientsnbsp fulfilled the inclusion criteria and were reviewed for the purpose of the study with male to female ratio of 1:1.6, average age of 45yearsnbsp ranging from 8 months to 72 years. A total of 5 post operative complications were identified: 2 nerve injuries, (neuropraxia which resolved within 6months and post operative tourniquet pain in 3 patients).nbsp The use of tourniquet was discontinued in 3 patients due to venous tourniquet effect with inadequate bloodless field. The duration of tourniquet varies between 30 minutes and 108 minutes with an average interval of 86 per 10minutes. Conclusion: The use of tourniquet is often followed with complications for which the pathophysiology, their preventive measures and management should be known by limb surgeons if they should arise.nbs