Traditional bone setters (TBS) are lay practitioners who manage fractures without formal medical qualification. In low- and middle-income countries (LMICs), TBS practitioners provide care for an estimated 10% to 85% of patients with fractures. Children are highlighted as a particularly vulnerable group because physeal immaturity and lower diastolic blood pressure thresholds increase their susceptibility to compartment syndrome at lower absolute intracompartmental pressures than adults. No prior systematic review has restricted analysis exclusively to the paediatric population or produced pooled meta-analytic estimates of TBS-related complication rates. This protocol describes a planned systematic review and meta-analysis to determine the pooled incidence of paediatric TBS-related complications across LMIC settings.
The review will search nine databases: PubMed/MEDLINE, Embase, Cochrane CENTRAL, African Index Medicus, Global Health/CABI, Scopus, LILACS, WHO ICTRP and the COSECSA Archive. Searches will be supplemented by grey literature sources. The team will use three complementary PubMed search strings and incorporate 15 verified vernacular synonyms for TBS practitioners — examples given in the protocol include Wegesha, Onisegun, Rebouteux, Huesero and Vaidya. Database searching commenced in April 2026 and, at the time of reporting in the protocol, is in progress. The protocol notes that no screening, data extraction, or analysis has yet been initiated.
The protocol states the review will focus on children, but the precise age range defining the paediatric population was not reported in the source document. Other eligibility details provided in the protocol are oriented to identifying paediatric patients treated by TBS in LMIC contexts; however, the full selection criteria (including study designs eligible, minimum follow-up, or exclusion criteria) are not detailed in the summary provided.
Primary outcomes specified for pooled estimation are:
These outcomes are the focus of the meta-analysis to quantify the burden of severe TBS-related complications in children across LMICs.
Risk of bias across included studies will be assessed using multiple tools suitable for different study designs: the Newcastle-Ottawa Scale (NOS), the MinCir scale, and the Mixed Methods Appraisal Tool (MMAT). The certainty of the body of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Pooled complication proportions will be calculated using the Freeman-Tukey double arcsine transformation to stabilize variances for proportion data. Random-effects models will be applied, specifically the DerSimonian-Laird method and restricted maximum likelihood (REML). The protocol plans to investigate lag time from injury to hospital presentation as a continuous moderator using meta-regression to assess its influence on complication rates. The protocol does not report any completed meta-analytic results at this stage; all analyses are planned pending completion of screening and data extraction.
As the review uses published and publicly available data, no primary data collection is undertaken and formal ethics approval is not required. Planned dissemination includes publication in peer-reviewed journals and presentations at orthopaedic and global surgery conferences. The protocol specifies a policy translation threshold: if pooled paediatric amputation rates exceed 30% among late-presenting patients, the authors will prepare and submit an evidence brief to the WHO Global Surgery Programme, the College of Surgeons of East, Central and Southern Africa (COSECSA) Global Surgery Commission, and national orthopaedic associations in Nigeria, Ghana, Ethiopia and Pakistan.
This systematic review and meta-analysis protocol is registered with PROSPERO under registration number CRD420261349595. The protocol provides methodological plans but, at the time of writing, database searches are ongoing and no study screening, data extraction, or analysis has been completed.