{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:15:34Z","timestamp":1791335734401,"version":"4.3.1"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,21]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In Ethiopia, orthopaedic services are limited, and many injured children undergo traditional bonesetting (TBS) despite its association with limb- and life-threatening complications. We sought to identify the risk factors for amputation and a prolonged hospitalization of &gt;7 days in children who presented to hospitals after undergoing TBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Over a 15-month period, we prospectively enrolled children who presented to 8 Ethiopian hospitals after undergoing TBS. Separately for each outcome (amputation and prolonged hospitalization), we used multivariable logistic regression to evaluate associations between the outcome and 16 covariates, including demographic and injury characteristics, parent or guardian preference for TBS, and TBS topical treatments and immobilization methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We enrolled 460 children (mean age, 9.0 \u00b1 4.0 years; 75% male) representing 8 Ethiopian regions and diverse demographic and socioeconomic backgrounds. Elbow injuries (194 patients; 42.2%) and closed fractures and\/or dislocations (364 patients; 79.1%) were most common. TBS treatments included topical inorganic (190 patients; 41.3%) or organic (82 patients; 17.8%) material application and rigid (166 patients; 36.1%) or soft (182 patients; 39.6%) immobilization. Twenty-six children (5.7%) underwent an amputation, and 102 (22.2%) had a prolonged hospitalization. The odds of amputation were higher for children from rural communities (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 2.01 to 22.41) and for children with only non-osseous injuries (AOR, 5.76; 95% CI, 1.56 to 21.28). The odds of prolonged hospitalization were higher for children who were 11 to 17 years old (AOR, 2.77; 95% CI, 1.18 to 6.50) and for children with open fractures with a grade of \u22652 (AOR, 4.52; 95% CI, 1.33 to 15.28) but were lower for children from households with secondary education or higher (AOR, 0.40; 95% CI, 0.21 to 0.79). TBS with rigid immobilization increased the odds of amputation (AOR, 5.84; 95% CI, 1.74 to 19.60) and prolonged hospitalization (AOR, 2.20; 95% CI, 1.02 to 4.73). TBS organic topical treatment (with mud, leaves, or butter) increased the odds of amputation (AOR, 3.88; 95% CI, 1.40 to 10.73).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>For children who underwent TBS prior to hospital presentation, rigid splinting by bonesetters increased the odds of amputation and prolonged hospitalization. TBS organic topical treatments also increased the odds of amputation. Training bonesetters to avoid these dangerous practices may prevent devastating complications for children in Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00359","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T14:02:01Z","timestamp":1739196121000},"page":"1050-1062","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Risk Factors for Amputation and Prolonged Hospitalization Among Children Who Received Traditional Bonesetting in Ethiopia"],"prefix":"10.2106","volume":"107","author":[{"given":"Ephrem G.","family":"Adem","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5622-524X","authenticated-orcid":false,"given":"Papa K.","family":"Morgan-Asiedu","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2841-8463","authenticated-orcid":false,"given":"Mengistu G.","family":"Mengesha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3624-0079","authenticated-orcid":false,"given":"Mario","family":"Keko","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1299-2302","authenticated-orcid":false,"given":"Chen","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sintayehu","family":"Bussa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden","family":"Alemu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yishak","family":"Zerihun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu T.","family":"Derilo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wachemo University Hospital, Hosaena, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9309-5795","authenticated-orcid":false,"given":"Mahamed","family":"Areis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Jigjiga University Hospital, Jijiga, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleab T.","family":"Reda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Gondar Specialized Hospital, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wubshet A.","family":"Workneh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Bahir Dar University Hospital, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahru A.","family":"Shiferaw","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Bahir Dar University Hospital, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3595-3405","authenticated-orcid":false,"given":"Moa C.","family":"Jira","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Haramaya General Hospital, Haramaya, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu B.","family":"Gula","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Assela University Hospital, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulugeta B.","family":"Geneti","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Jimma University Medical Center, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-1196","authenticated-orcid":false,"given":"Claude","family":"Martin","sequence":"additional","affiliation":[{"name":"AO Alliance Foundation, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-5950","authenticated-orcid":false,"given":"Kiran J.","family":"Agarwal-Harding","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7229-0041","authenticated-orcid":false,"given":"William J.","family":"Harrison","sequence":"additional","affiliation":[{"name":"AO Alliance Foundation, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"issue":"1","key":"bib1-20250526","first-page":"35","article-title":"Determinants of utilization of traditional bone setters in Ilorin, north central Nigeria","volume":"54","author":"Aderibigbe","year":"2013","journal-title":"J Prev Med Hyg."},{"issue":"1","key":"bib2-20250526","doi-asserted-by":"crossref","first-page":"418","DOI":"10.4314\/ahs.v21i1.52","article-title":"Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania","volume":"21","author":"Card","year":"2021","journal-title":"Afr Health Sci."},{"issue":"1","key":"bib3-20250526","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5334\/aogh.2878","article-title":"Practices and perspectives of traditional bone setters in Northern Tanzania","volume":"86","author":"Card","year":"2020","journal-title":"Ann Glob Health."},{"issue":"2","key":"bib4-20250526","first-page":"262","article-title":"Review of the practice of traditional bone setting in Nigeria","volume":"11","author":"Dada","year":"2011","journal-title":"Afr Health Sci."},{"key":"bib5-20250526","doi-asserted-by":"crossref","first-page":"189","DOI":"10.11604\/pamj.2018.30.189.15730","article-title":"Complications of traditional bone setters (TBS) treatment of musculoskeletal injuries: experience in a private setting in Warri, South-South Nigeria","volume":"30","author":"Odatuwa-Omagbemi","year":"2018","journal-title":"Pan Afr Med J."},{"issue":"1","key":"bib6-20250526","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1186\/s13104-019-4643-z","article-title":"Preference of Traditional Bone Setting and associated factors among trauma patients with fracture at Black Lion Hospital in Addis Ababa, Ethiopia: institution based cross sectional study","volume":"12","author":"Worku","year":"2019","journal-title":"BMC Res Notes."},{"key":"bib7-20250526","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1746-4269-7-39","article-title":"The contribution of traditional healers\u2019 clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study","volume":"7","author":"Birhan","year":"2011","journal-title":"J Ethnobiol Ethnomed."},{"issue":"6","key":"bib8-20250526","first-page":"207","article-title":"Fracture complications after treatment by traditional bonesetters in Northern Ghana","volume":"4","author":"Callistus","year":"2013","journal-title":"Adv Appl Sci Res."},{"issue":"10","key":"bib10-20250526","doi-asserted-by":"crossref","first-page":"e031525","DOI":"10.1136\/bmjopen-2019-031525","article-title":"Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care","volume":"9","author":"Starr","year":"2019","journal-title":"BMJ Open."},{"issue":"10","key":"bib11-20250526","first-page":"e135","article-title":"Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study","volume":"17","author":"Denu","year":"2022","journal-title":"Disaster Med Public Health Prep."},{"issue":"Suppl 1","key":"bib12-20250526","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12960-016-0126-7","article-title":"The surgical workforce shortage and successes in retaining surgical trainees in Ethiopia: a professional survey","volume":"14","author":"Derbew","year":"2016","journal-title":"Hum Resour Health."},{"issue":"12","key":"bib13-20250526","first-page":"95","article-title":"Complications of Fracture Treatment by Traditional Bone Setters in Wolaita Sodo, southern Ethiopia","volume":"3","author":"Kumma","year":"2013","journal-title":"J Biol Agric 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Surg."},{"issue":"1","key":"bib17-20250526","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12960-020-00468-w","article-title":"Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters","volume":"18","author":"Onyemaechi","year":"2020","journal-title":"Hum Resour Health."},{"issue":"11","key":"bib18-20250526","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1111\/tmi.13662","article-title":"Complications of traditional bonesetting in contemporary fracture care in low- and middle-income countries: A systematic review","volume":"26","author":"Onyemaechi","year":"2021","journal-title":"Trop Med Int Health."},{"issue":"1","key":"bib20-20250526","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4103\/1117-1936.175250","article-title":"Limb gangrene following treatment of limb injury by traditional bone setter (Tbs): a report of 15 consecutive cases","volume":"12","author":"Nwankwo","year":"2005","journal-title":"Niger Postgrad Med J."},{"issue":"1","key":"bib21-20250526","doi-asserted-by":"crossref","DOI":"10.4103\/1357-6283.101508","article-title":"The Practice and Tradition of Bonesetting Background and Context","volume":"23","author":"Agarwal","year":"2010","journal-title":"Educ Health."},{"issue":"1","key":"bib22-20250526","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1302\/0301-620X.87B1.15585","article-title":"The prevention of traditional bone setter\u2019s gangrene General orthopaedics","volume":"87","author":"Eshete","year":"2005","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib23-20250526","doi-asserted-by":"crossref","first-page":"194","DOI":"10.18203\/issn.2455-4510.IntJResOrthop20210613","article-title":"Traditional bone setting: an avoidable cause of major limb amputations","volume":"7","author":"Salihu","year":"2021","journal-title":"Int J Res Orthop."},{"issue":"7","key":"bib24-20250526","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.18203\/2320-6012.ijrms20202889","article-title":"Lower extremity gangrene in children from traditional bone setters care: an avoidable cause of limb loss","volume":"8","author":"Echem","year":"2020","journal-title":"Int J Res Med Sci."},{"issue":"1","key":"bib25-20250526","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12906-023-03951-8","article-title":"Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia","volume":"23","author":"Endeshaw","year":"2023","journal-title":"BMC Complement Med Ther."},{"issue":"9","key":"bib26-20250526","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/j.ejrad.2011.06.030","article-title":"Complications and co-morbidities in radiographs of patients in traditional bone setters\u2019 homes in Ogwa, Edo State, Nigeria: a community-based study","volume":"81","author":"Eze","year":"2012","journal-title":"Eur J Radiol."},{"issue":"2","key":"bib27-20250526","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/1117-6806.188993","article-title":"Reasons for patronage of traditional bone setters","volume":"22","author":"Abang","year":"2016","journal-title":"Niger J Surg."},{"key":"bib28-20250526","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2174\/1874325001105010020","article-title":"Traditional bonesetters and contemporary orthopaedic fracture care in a developing nation: historical aspects, contemporary status and future directions","volume":"5","author":"Nwachukwu","year":"2011","journal-title":"Open Orthop J."},{"issue":"4","key":"bib29-20250526","first-page":"320","article-title":"Performance of a trained traditional bonesetter in primary fracture care","volume":"96","author":"Onuminya","year":"2006","journal-title":"S Afr Med J."},{"issue":"2","key":"bib30-20250526","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s002640050320","article-title":"Traditional bone setter\u2019s gangrene","volume":"23","author":"Onuminya","year":"1999","journal-title":"Int Orthop."},{"issue":"1","key":"bib31-20250526","first-page":"401","article-title":"EL Hag OBM. Complications in fractures treated by traditional bone setters in Khartoum, Sudan","volume":"3","author":"EL Hag","year":"2010","journal-title":"Khartoum Medical Journal."},{"issue":"10","key":"bib32-20250526","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1053\/jpsu.2000.16406","article-title":"Bone setter\u2019s gangrene","volume":"35","author":"Bickler","year":"2000","journal-title":"J Pediatr Surg."},{"key":"bib33-20250526","doi-asserted-by":"crossref","first-page":"3747698","DOI":"10.1155\/2022\/3747698","article-title":"Clinical Outcomes and Predictors of Patients with Fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia: A Prospective Cohort Study","volume":"2022","author":"Yimenu","year":"2022","journal-title":"Adv Orthop."},{"issue":"5","key":"bib34-20250526","article-title":"Factors Associated with Fracture and Its Outcome at Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Southern Ethiopia","volume":"7","author":"Getu","year":"2017","journal-title":"J Biol Agric Healthc."},{"issue":"2","key":"bib35-20250526","doi-asserted-by":"crossref","first-page":"129","DOI":"10.47985\/dcidj.588","article-title":"Integrating Traditional Bone-Setting and Orthopaedic Medicine Practices in the Management of Fractures in Nigeria: Community-Based Rehabilitation Model in Perspective","volume":"33","author":"Iyor","year":"2022","journal-title":"Disabil CBR Incl Dev."},{"issue":"1","key":"bib36-20250526","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/00494755221122543","article-title":"Systematic review of complications associated with treatment by traditional bone setters for musculoskeletal injury","volume":"53","author":"Garikapati","year":"2023","journal-title":"Trop Doct."},{"issue":"1","key":"bib37-20250526","article-title":"The continued role for traditional bonesetters in East and West Africa: An expert consensus 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Surg."},{"issue":"24","key":"bib41-20250526","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.2106\/JBJS.22.01304","article-title":"Training Traditional Bonesetters in Basic Principles of Fracture Treatment: A Proof of Concept in Ghana","volume":"105","author":"Konadu-Yeboah","year":"2023","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib42-20250526","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12873-023-00805-x","article-title":"Fall injuries in Sub-Saharan Africa: analysis of prospective injury registry from 23 health facilities in Malawi and Tanzania","volume":"23","author":"Sawe","year":"2023","journal-title":"BMC Emerg Med."},{"issue":"4","key":"bib43-20250526","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4103\/0019-5413.43370","article-title":"Open fractures","volume":"42","author":"Babhulkar","year":"2008","journal-title":"Indian J 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