A. Ikpeme

Reasons for patronage of traditional bone setters

Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS. Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS′ treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20. Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.

Dynamic Screw Systems without Image Intensifier: Early Observations in Eight Consecutive Patients

Abstract Dynamic Screw Systems are useful in proximal and distal femoral fractures, and convey advantages over fixed angle devices. Improved proximal fragment fixation, controlled fracture impaction and a “forgiveness” with respect to axial alignment of the side plate to bone are improvements over fixed angle devices. Image intensifiers are often required to aid lag screw alignment when these devices are used. The equipments are expensive and often not available in some regions of the developing world. There is also the risk of radiation exposure to the surgical team. The burden of musculoskeletal trauma is enormous in the developing world and treatment outcomes are influenced by a host of factors. The choice of the best treatment options for patients in these resource-poor regions remains a challenge. Improvisations that aid appropriate treatment while conveying documented advantages is key to patient care in musculoskeletal disease in these regions. We document our experience in a small cohort of patients who accepted treatment of their fractures with Dynamic Screw devices in a setting without image intensifiers. Technical advances and modifications that reduce the cost of fracture care have the potential of reducing the overall cost of care in the developing world and may offer universal benefits