Lower extremity gangrene in children from traditional bone setters care: an avoidable cause of limb loss


  • Richard C. Echem Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
  • Phillip D. Eyimina Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria




Children, Gangrene, Lower extremity, Traditional bone setters


Background: Worldwide, lower extremity gangrene in children is rare. In orthopaedic practice in developing countries, a frequent cause of extremity gangrene is the practice of traditional bone setting. Aim of the study was to document lower extremity gangrene in children resulting from the care of traditional bone setters’ as seen in a tertiary health institution.

Methods: A prospective study of children presenting with lower extremity gangrene from the care of traditional bone setters at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018. Data obtained included the patients socio-demographics and relevant information related to the diagnosis. Data was analysed with SPSS version 20.

Results: Eighteen children with lower extremity gangrene were seen. Their ages ranged from 10 days to 132 months. There was a female preponderance. Their parents mostly had primary and secondary levels of education and majority were married. The most common diagnosis was tibiofibular fractures followed by congenital clubfoot. Trauma-related injuries were mostly from falls. Duration before presentation ranged from 7 to 28 days. Majority had massage, splinting and bandaging from the bone setter. Most common associated complication at presentation was sepsis. All had provisional amputation. Most common amputation was below knee. Most had stump refashioning within 15 days. One had split skin grafting. There was one mortality. Duration of hospital stay ranged from 3 to 65 days.

Conclusions: Children at any age can develop lower extremity gangrene from traditional bone setters’ care. This is an avoidable and preventable sequelae of care. Parental health education is necessary to discourage their patronizing traditional bone setters.


Farrar MJ, Bennet GC, Wilson NI, Azmy A. The orthopaedic implications of peripheral limb ischaemia in infants and children. J Bone Joint Surg Br. 1996;78(6):930-3.

Rasool MN, Pryce-Lewis J, Smit R. Ischaemia of the foot in infants. S Afr Orthop J. 2009;8:72-5.

Gilbert EF, Hogan GR, Stevenson MM, Suzuki H. Gangrene of an extremity in the newborn. Pediatrics. 1970;45(3):469-72.

Urimubabo JC, Byiringiro F, Ssebuufu R, Fawcett V. Symmetrical peripheral gangrene in two children at the University Teaching Hospital of Butare (CHUB): a report of two cases. Rwanda Med J. 2015;72(3):25-7.

Ejagwulu FS, Ibrahim A. Symmetrical peripheral gangrene and extremity amputations. Ann Niger Med. 2014;8(2):98-102.

Martins DB, Amado V, Langa S, Ventura J, Taela A, DeUgarte DA. Malaria-associated peripheral gangrene. J Pediatr Surg Case Rep. 2014;2:417-20.

Singh J, Rattan KN, Gathwala G, Kadian YS. Idiopathic unilateral lower limb gangrene in a neonate. Indian J Dermatol. 2011;56(6):747-8.

Musa AA. A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene. Afr Health Sci. 2006;6(1):49-50.

Salawu ON. Neonatal lower limb gangrene: avoidable causes noticed North-West Nigeria. J Orthop Traumatol Rehabil. 2017;9(1):53-5.

Nwankwo OE, Katchy AU. Limb gangrene following treatment of limb injury by traditional bone setter (TBS): a report of 15 consecutive cases. Niger Postgrad Med J. 2005;12(1):57-60.

Nwadiaro HC. Bone setters’ gangrene. Niger J Med. 2007;16(1):8-10.

Agu TC, Onyekwelu J. Traditional bone setters’ gangrene: an avoidable catastrophe, 8 years retrospective review in a private orthopaedic and trauma center in south-east Nigeria. Niger J Gen Pract. 2016;14(1):1-5.

Agarwal A, Agarwal R. The practice and tradition of bonesetting. Educ Health (Abingdon). 2010;23(1):225.

Ekere AU, Echem RC. Complications of fracture and dislocation treatment by traditional bone setters: a private practice experience. Niger Health J. 2011;11(4):131-8.

Nwadiaro HC, Nwadiaro PO, Kidmas RA. Principles of traditional bone setting in the middle belt of Nigeria: a critical appraisal. Niger J Surg Res. 2004;6(3-4):114-8.

Onuminya JE. The role of the traditional bonesetter in primary fracture care in Nigeria. S Afr Med J. 2004;94(8):652-8.

Omololu AB, Ogunlade SO, Gopaldasani VK. The practice of traditional bonesetting: training algorithm. Clin Orthop Relat Res. 2008;466(10):2392-8.

Eshete M. The prevention of traditional bone setter’s gangrene. J Bone Joint Surg Br. 2005;87(1):102-3.

Sami AL, Anjum N, Shaukat M, Hanif A, Siddique K. Pattern and mode of trauma for child amputation at tertiary care hospital. Ann King Edward Med Univ. 2012;18(1):81-7.

de Godoy JM, de Godoy LM. Epidemiological data of amputations in children. Clin Pediatr Dermatol. 2016;2(2):8.

Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J. 2010;30:7-14.

Umaru RH, Gali BM, Ali N. Role of inappropriate traditional splintage in limb amputation in Maiduguri, Nigeria. Ann Afr Med. 2004;3(3):138-40.

Onuminya JE, Onabowale BO, Obekpa PO, Ihezue CH. Traditional bone setter’s gangrene. Int Orthop. 1999;23(2):111-2.

Onuminya JE, Obekpa PO, Ihezue HC, Ukegbu ND, Onabowale BO. Major amputations in Nigeria: a plea to educate traditional bone setters. Trop Doct. 2000;30(3):133-5.

Akinyoola AL, Oginni LM, Adegbehingbe OO, Orimolade EA, Ogundele OJ. Causes of limb amputations in Nigerian children. West Afr J Med. 2006;25(4):273-5.

Salawu ON, Babalola OM, Mejabi JO, Fadimu AA, Ahmed BA, Ibraheem GH, et al. Major extremity amputations: indications and post-surgery challenges in a Nigeria tertiary institution. Sahel Med J. 2019;22(1):8-12.

Udosen AM, Ugare G, Ekpo R. Generalized tetanus complicating lower limb fractures managed by traditional bone healers. Trop Doct. 2005;35(4):237-9.

Adesina SA, Amole IO, Awotunde OT, Eyesan SU, Durodola AO, Adeniran A, et al. Family structure and bonesetter’s gangrene in children: a case series. Int J Trop Dis Health. 2016;14(2):1-8.

Olugbade OM, Taiwo AO, Ajaiyi OA, Faniran AA, Adebawojo OO, Ojelabi SO, et al. Avoidable birth injury complicated with limb gangrene: a reflection of an in-efficient health system. Niger J Paediatr. 2016;43(1):54-7.

Yasin S, Ayana B, Bezabih B, Wamisho B. Causes of pediatric limb amputations at Tikur Anbessa Specialized Hospital and the role of traditional bone setters (“Wogeshas”). Ethiop Med J. 2018;56(2).

Yinusa W, Ugbeye ME. Problems of amputation surgery in a developing country. Int Orthop. 2003;27(2):121-4.

Chalya PL, Mabula JB, Das RM, Ngayomela IH, Chandika AB, Mbelenge N, et al. Major limb amputations: a tertiary hospital experience in northwestern Tanzania. J Orthop Surg Res. 2012;7:18.




How to Cite

Echem, R. C., & Eyimina, P. D. (2020). Lower extremity gangrene in children from traditional bone setters care: an avoidable cause of limb loss. International Journal of Research in Medical Sciences, 8(7), 2524–2530. https://doi.org/10.18203/2320-6012.ijrms20202889



Original Research Articles