{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:14:54Z","timestamp":1790345694425,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Low\u2010 and middle\u2010income countries (LMICs) experience the highest rates of injury\u2010related deaths globally, exacerbated by a lack of robust emergency medical services (EMS). Though fractures contribute substantially to global injury, little is known about prehospital management of extremity fractures in LMICs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This review included literature published between January 2000 and January 2024. Inclusion criteria pertained to prehospital settings, defined as care rendered prior to hospital presentation, including care provided by lay first responders (LFRs), professional EMS personnel, and traditional bonesetters (TBS). Multiple authors used the Newcastle\u2010Ottawa scale to assess texts meeting inclusion criteria, extracting relevant details for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1251 articles identified, 25 met inclusion criteria. Studies spanned 9 countries across 4 continents, with 14 articles studying care by TBS, 9 by LFRs, and 2 by other prehospital providers. LFR training courses report a combined weighted average pre\u2010\/post\u2010course difference of 29.16 percentage points. A total of 67% of included studies report adverse outcomes associated with TBS\u2010managed fractures in the prehospital setting. TBS care is often sought prior to hospital presentation due to sociocultural beliefs, accessibility, and cheaper costs. Few training courses for TBS have been performed, though one course reports a 20.4% increase in fracture management knowledge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In certain resource\u2010limited settings, TBS provide most initial fracture management, which may adversely impact outcomes. Knowledge transfer has been demonstrated during prehospital fracture management courses for LFRs and TBS. Early evidence suggests TBS training and integration into healthcare systems may reduce complication rates, improving long\u2010term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12678","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T03:24:01Z","timestamp":1752290641000},"page":"2255-2263","source":"Crossref","is-referenced-by-count":5,"title":["Prehospital Extremity Fracture Management in Low and Middle\u2010Income Countries: A Scoping Review of Lay First Responders and Traditional Bonesetters"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7126-9203","authenticated-orcid":false,"given":"Aayush","family":"Unadkat","sequence":"first","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"LFR International  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3988-1322","authenticated-orcid":false,"given":"Emily","family":"Stoller","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6420-481X","authenticated-orcid":false,"given":"Haleigh","family":"Pine","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8512-7294","authenticated-orcid":false,"given":"Zachary J.","family":"Eisner","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0946-2581","authenticated-orcid":false,"given":"Maxwell C.","family":"Klapow","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Department of Social Policy and Intervention University of Oxford Department of Experimental Psychology  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5010-9735","authenticated-orcid":false,"given":"Ashwin J.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Department of Anesthesiology University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5078-2167","authenticated-orcid":false,"given":"Anagha","family":"Thiagarajan","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"University California Irvine School of Medicine  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8145-7633","authenticated-orcid":false,"given":"Nathanael","family":"Smith","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Department of Emergency Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5644-2751","authenticated-orcid":false,"given":"Peter G.","family":"Delaney","sequence":"additional","affiliation":[{"name":"LFR International  Los Angeles California USA"},{"name":"Cleveland Clinic Department of Orthopaedic Surgery  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Injuries and Violence: The Facts 2014","author":"World Health Organization","year":"2014"},{"key":"e_1_2_10_3_1","volume-title":"Falls [Internet]","author":"World Health Organization","year":"2021"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873\u2010019\u20100237\u20102"},{"key":"e_1_2_10_5_1","volume-title":"StatPearls [Internet]","author":"Powell R. 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