Contributions of Traditional Bone Setters to Fracture Management in Nigeria: An Ethnographic and Clinical Outcome Study

Traditional bone setters (TBS) are the primary source of fracture management for the majority of Nigerians, particularly in rural and semi-urban communities. The clinical outcomes of TBS-managed fractures and the ethnographic dimensions of TBS practice represent a critical but under-investigated area of surgical research. This dissertation provides an integrated ethnographic and clinical outcome analysis of TBS fracture management across North Central, North East, and North West geopolitical zones. The ethnographic component comprised 18 months of fieldwork, including participant observation at 12 TBS practice sites and 60 in-depth interviews with TBS, patients, and healthcare workers. The clinical component analyzed outcomes of 320 patients presenting to tertiary hospitals following TBS management, compared to 320 matched patients with hospital-treated fractures. TBS practices varied significantly by zone, with herbal splinting, manipulation, and prolonged immobilization as common techniques. Clinical outcomes showed TBS-managed fractures had significantly higher rates of malunion (38% versus 8%), soft tissue complications (29% versus 9%), and compartment syndrome (12% versus 2%). However, patient satisfaction with TBS care was paradoxically higher, driven by cost, proximity, and cultural affinity. The dissertation offers an original integrative model for constructive TBS-healthcare system engagement and recommends structured TBS training programs, referral partnerships, and legislation to minimize preventable TBS-related complications. Keywords: traditional bone setters, fracture management, ethnography, Nigeria, orthopaedic outcomes