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Bone setter's gangrene
Gangrene usually supervenes following prolonged pressure of tight splintage by traditional bone setters (TBS) in the process of treating fractures. However, various complications such as blisters, pressure sores, Volkmann's ischaemia/ contracture, Crush syndrome and pregangrene occur by the same mechanism depending on degree of pressure and duration of splintage of the limb.
This is a guest lecture delivered to resident doctors. Literature search was done through the internet and some unlisted journals and texts. Experiences of various institutions in Nigeria and abroad concerning bone setters' gangrene were elucidated. Attempt was made to broaden the concept of bone setters' gangrene to include all complications that arise through the same mechanism. The aetiology, pathophysiology and treatment of the various conditions were highlighted and the solution and way-forward suggested.
The various health institutions recorded unacceptably high percentage of amputations secondary to bone setters' gangrene e.g. Zaria - 57% to 63%, Jos - 60-77.8%. Enugu recorded mortality of 26.7% while Banjul had 11.1% mortality in their series. Nearly all the series suggested education of bone setters as a solution.
A different approach to limiting bone setters' gangrene is suggested such as condemning bone setters' practice and expanding orthopaedic care.
Nigerian Journal of Medicine Vol. 16 (1) 2007: pp. 8-10