Bone-setting and Physical Medicine

Traditional bone-setting na the part of Yoruba medicine where evidence clear pass, and the evidence dey bring wahala to both sides. Na the only major area wey get plenty published research on wetin dey happen after treatment, including one systematic review wey cover 1,389 patients and 1,470 complications 1. That research show say serious damage dey happen for many people, like amputations wey for no happen at all. But e still show something wey the numbers of harm alone no show: say na bone-setter dey treat most of the broken bone cases for Nigeria, say the results dey okay for some types of injury, and say wetin dey available for most of the patients no be orthopaedic surgeon, but nothing at all.

The confidence level on top this file high well-well, wey no common for this section. Na because wetin dey here depend on hospital research wey count real patients, instead of just general story or wetin traditional healers report by themselves.

Wetin the bone-setter dey do

The onímọ̀-egúngun or traditional bone-setter, wey some people dey call ọ̀gbẹ́ni egungun, dey treat broken bone (fracture), bone wey shift comot for joint (dislocation), sprain, and other bone or muscle injury. The main way wey dem dey take do am na to use hand arrange the bone back into place, den tie am make e no move with splints, mostly bamboo or wood planks, wey dem tie with cloth or rope, plus herbal medicine wey dem dey rub on top the skin and massage. The treatment dey take long time and dem dey tie am again and again over several weeks or months, and payment dey often come in bits as the treatment dey go on.

Dem dey pass the work inside family through informal learning from relations, without any formal training structure or school curriculum 23. No official body dey wey dey give license or certificate. The 2011 review of Nigerian research summarize the matter straight: nobody really know where the work start from, e dey pass from one generation go another, and no formal training dey for bone-setters 2.

Wetin the results really be

How plenty the complications reach. The systematic review wey Onyemaechi and im colleagues do for Tropical Medicine and International Health follow PRISMA guidelines, check 176 research papers, select 15 hospital observational studies wey dem publish between 1986 and 2018, and e cover 1,389 patients wey reach orthopaedic hospital with 1,470 complications from traditional bone-setter treatment 1. Wetin the paper conclude get two sides and any honest explanation must include the two: the complications from traditional bone-setting dey cause serious sickness and disability, and traditional bone-setters get the power to help well for treating broken bones if dem give dem proper training 1.

The complications dem self. The main ones wey dey recorded across Nigerian literature na bone wey join bend (malunion), bone wey refuse to join (nonunion), serious bone infection (traumatic osteomyelitis), and hand or leg wey decay (limb gangrene) 4. One Nigerian research on outcomes report say 49.0 percent of patients see the treatment as satisfactory, 40.8 percent say e fair, and 10.2 percent say e no good at all, with complications wey include pain, malunion or nonunion, joint stiffness, and contracture wey happen to 61.2 percent 4. For one hospital comparison, pass half of the group wey go traditional bone-setter get malunion, and one-quarter get nonunion 4.

Gangrene and amputation na the main signature damage. The 2011 review identify gangrene for hand or leg as the worst outcome from the practice, and e use the need to stop this kind heavy damage, like amputation, build the case for training 2. This one no be rare complication wey dem just write to make mouth; na the main reason why orthopaedic surgeons for Nigeria dey write about traditional bone-setting at all.

Dem understand how the problem dey happen. When dem tie splint too tight round hand or leg wey dey swell, e dey block blood and cause compartment syndrome, wey dey lead to gangrene, wey go later cause amputation. Open wound wey dem tie under native medicine without cleaning and washing comot dirty (debridement) dey cause osteomyelitis. Broken bone wey dem arrange with ordinary hand and tie without X-ray dey heal for the bent position wey dem leave am, and that one dey cause malunion. Every complication wey dem document get clear physical explanation, and that explanation show exactly wetin training need to change.

The main point to note: e depend on the kind fracture

The most useful thing wey come out from all this research na say the results no dey the same for every type of injury.

Results dey good for closed fractures wey happen for the middle shaft of humerus, ulna, radius, and tibia bones. But results dey bad for fractures wey dey near joint (peri-articular) and for open fractures 4.

This difference make sense and e important make dem explain am well, because na wetin divide explanation wey follow evidence from ordinary brushing-aside. Closed shaft fracture mostly need make dem just hold am tight make e no move while e dey heal. To make bone no move na exactly wetin traditional bone-setter dey provide, and e dey do am for cheap price, close to house, with steady care throughout the whole healing period. Open fracture need proper wound washing and cleaning, infection control, and many times internal fixation with metal. Fracture wey enter inside joint need exact arrangement down to one or two millimetres, wey person no fit achieve with ordinary hand touching. Na these exact kinds of injury make im results dey bad, and the reason no be say e careless, but say the medical procedures wey dem need no dey im reach.

So the correct summary no be say traditional bone-setting just dey dangerous totally. Na say traditional bone-setting dey okay for some group of injuries and dey dangerous for another group, say the bone-setter no get reliable way to know which one be which without X-ray (radiography), and say e dey treat both of dem.

Why patients dey go

Na here reports wey dem write from inside hospital dey usually miss road, and the survey data come set the record straight.

One study of 120 patients for Makurdi wey traditional bone-setters first treat before dem come hospital record di reasons: advice from family and friends na di most common reason at 29.2 percent, follow by cheaper cost at 25 percent, sociocultural belief at 14.2 percent, how e easy to reach at 12.5 percent, fear of amputation at 10.8 percent, and fear of operation at 8.3 percent 5. None of dis factors get connection with age, marital status, work or level of education 5.

Two things inside dat list deserve attention.

Di biggest single driver na social, no be ideological. People dey go where their relatives send dem. Na only 14.2 percent give sociocultural belief as reason, wey small pass wetin di claim say "dem believe in traditional medicine" dey make people expect.

Fear of amputation and fear of operation together make up almost one-fifth. Patients dey go meet bone-setter partly to avoid surgeon wey dem dey fear say go cut their hand or leg comot. Di tragedy wey dey inside dat finding no need long explanation: di attempt to avoid amputation na one of di reasons why patients dey choose di treatment wey dey cause am pass.

Di same study find out say patients dey mostly lose confidence after di experience. When dem ask dem about di result of di treatment wey dem get, nobody rate am as very satisfactory, 20 percent talk say e satisfactory but e get issues, 66.7 percent talk say e no satisfactory, and 13.3 percent no get opinion 5. When dem ask dem about di practice generally, 35 percent think say bone-setters no useful and 25 percent see dem as nuisance, compare to 31.7 percent wey see dem as useful and 8.3 percent wey talk say dem indispensable 5.

Dat na group of patients wey get low opinion about service wey dem still dey continue to use, wey be clear sign of market wey no get alternative rather than cultural preference. Make we also note di selection problem inside dat study, and for di outcome literature generally: dis na patients wey come hospital after traditional treatment, wey mean say na people wey their treatment fail full di sample pass. Patients wey their fracture heal well never enter di sample at all. Di complication studies dey measure di harm accurately, but dem no fit measure di normal rate of success at all.

Di number dey high for real. Inside one five-year multi-centre study of 4,216 missile and blast injury patients for southeastern Nigeria, 772 patients, wey be 18.3 percent, sign against medical advice go meet traditional bone-setters 6. Dis na patients wey already dey teaching hospital with gunshot injury wey choose to leave.

Surgery and im limits

Di tradition include cutting, but e dey important make person no overstate wetin dat mean.

Di olola na di specialist for cutting, and im documented work na circumcision, facial marks (ilà) and scarification 7. Dat na skilled and standard cutting of skin, wey dem dey do well well, and na genuine surgical craft for di strict sense of di word.

Aside dis one, record no support claims say developed Yoruba surgical tradition dey. No record dey of laparotomy, internal fixation, or operative management of fracture. Incision to drain abscess and making of shallow cuts to take put medicine, wey be regular way to administer medicine described inside file 01, dey inside wetin dem dey do. Di factors wey limit am na di same things wey limit surgery everywhere before late nineteenth century: no anaesthesia pass wetin plant and alcohol fit give, no antisepsis, no way to control heavy bleeding, and no way to manage infection once e start. Claims dey circulate about extensive traditional African surgery, and where dem concern Yoruba practice specifically, dis compiler no find any supporting evidence, so e no repeat dem.

Di integration debate

Di argument don move decisively comot from suppression, and di reason na arithmetic instead of sentiment. Traditional bone-setters dey provide di majority of primary fracture care for Nigeria 3. Orthopaedic surgeons no reach to replace dem, and dem no go reach anytime soon for any planning horizon. Policy to ban dem go comot di only health provider wey most fracture patients fit reach, and e no go even possible to enforce am anyway.

Di feasibility work. Onyemaechi and im colleagues conduct focus groups with five traditional bone-setters and eight orthopaedic surgeons for Enugu 3. Di findings: bone-setters learn their skills through informal apprenticeship from relatives, dem recognize say need dey to formalize their training, and dem dey willing to accept training support from orthopaedists; di orthopaedists recognize say bone-setters dey fill gap wey shortage of surgeons cause, and dem dey willing to provide training 3. Di authors conclude say formal training of bone-setters by orthopaedic surgeons dey feasible, and say dis one dey critical to integrate dem into di primary health care system as orthopaedic technicians 3. Di 2011 review reach di same conclusion from di outcome side: anywhere dem don try training, dem notice improvement for their performance 2.

Di first trial evidence. One pilot stepped-wedge cluster-randomised controlled trial on collaborative triage and treatment with traditional bone-setters for patients wey get extremity fracture run for rural Tanzania between August 2023 and April 2024, with 21 intervention and 31 control patients, and dem publish am for BMJ Global Health in November 2025 8. Dis one no be Nigeria and no be Yoruba practice, and person suppose mention dat caveat when dem dey cite am, but na di first randomised evidence on top dis mata anywhere. Wetin di study find: protocol adherence na 66.7 percent for di intervention group, where prohibitive cost and fear of surgery na di common reasons why people no follow protocol; mean satisfaction, quality of life and disability no get statistical difference between di groups; intervention patients get 0.072 fewer complications pass controls, wey mean number needed to treat na 13.9 to prevent one complication; and di authors conclude say collaborative fracture management dey acceptable and safe for patients and bone-setters, and e provide model for places wey get limited resources 8.

Read dat trial carefully. E small, na pilot, di confidence around di difference of 0.072 complications per patient for 52 patients wide, and e no show any difference for di outcomes wey patients care about pass. Wetin e establish na feasibility and acceptability, no be effectiveness. Na starting point, no be result.

Wetin integration go need change. Di ways wey harm dey happen wey dem identify above point to short and specific list: make dem no tie something round limb wey dey swell; recognise and refer open fractures; recognise and refer fractures wey affect joints; recognise signs of compartment syndrome and vascular compromise come refer immediately; and make place dey where dem go refer people go. Na dat last item be wetin no dey inside traditional bone-setter power, and na why training programmes wey no follow functioning referral pathways dey solve only half of di problem.

Wetin person fit talk

Traditional bone-setting dey cause documented, serious harm wey person fit prevent, including loss of limb, and dem establish dis one through counted outcomes, no be just mouth talk 124. Even with dat, na still di main source of fracture care for Nigeria and di results dey acceptable for closed shaft fractures, wey make up big portion of all fractures 34. Wetin dem publish show say di direction wey Nigerian orthopaedic surgeons dey follow, as dem dey see di complications, na towards training and integration instead of complete ban, and di first randomised evidence dey support say dis approach dey acceptable, even though e never show effectiveness yet 138.

Any account wey report only di gangrene figures, or only di access argument, dey report only half of di literature wey talk di two.