--- title: "Paediatric fracture complications after traditional bone setting in LMICs: systematic review and m" id: "bmj-open-5-paediatric-fracture-complications-following-traditional-bone-setting-in-low-and" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-5-paediatric-fracture-complications-following-traditional-bone-setting-in-low-and" content_type: "clinical_feed_article" specialty: "Pediatrics" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/10/e120252?rss=1" published_at: "2026-10-06T11:59:03.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Paediatric fracture complications after traditional bone setting in LMICs: systematic review and m ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-5-paediatric-fracture-complications-following-traditional-bone-setting-in-low-and - **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/10/e120252?rss=1) - **Published At:** 2026-10-06T11:59:03.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - Traditional bone setters (**TBS**) are lay practitioners who treat fractures without formal medical qualification and manage an estimated 10%–85% of fracture patients in low- and middle-income countries (LMICs). - Children are at increased risk from TBS treatment because of **physeal immaturity** and lower diastolic blood pressure thresholds that raise susceptibility to compartment syndrome at lower absolute intracompartmental pressures than adults. - No prior systematic review has focused exclusively on the **paediatric** population or provided pooled meta-analytic estimates of TBS-related complication rates; this protocol aims to fill that gap. - 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) plus grey literature, using three PubMed search strings and 15 verified vernacular synonyms for TBS practitioners (examples include Wegesha, Onisegun, Rebouteux, Huesero and Vaidya). - Database searching began in April 2026 and is ongoing; no screening, data extraction, or analysis has yet been performed. - The protocol's eligibility criteria specify a paediatric population but the exact age range was not reported in the source document. - Primary outcomes to be pooled are: major limb **amputation**, bonesetter's gangrene, **Volkmann's Ischaemic Contracture (VIC)**, and sepsis-related mortality. - Risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS), the MinCir scale, and the Mixed Methods Appraisal Tool (MMAT). - Meta-analytic methods include pooled complication proportions calculated with the Freeman-Tukey double arcsine transformation under random-effects models (DerSimonian-Laird and REML). Lag time from injury to hospital presentation will be modeled as a continuous moderator in meta-regression. - The certainty of evidence will be evaluated using GRADE. No primary data collection is involved and formal ethics approval is not required. - Results will be submitted to peer-reviewed journals and presented at orthopaedic and global surgery conferences; if pooled paediatric amputation rates exceed 30% in late-presenting patients, an evidence brief will be prepared for WHO Global Surgery Programme, the COSECSA Global Surgery Commission, and national orthopaedic associations in Nigeria, Ghana, Ethiopia and Pakistan. - The protocol is registered with PROSPERO (CRD420261349595). ## Clinical Analysis & Structured Key Points Introduction and aims Traditional bone setters (TBS) - lay practitioners who manage fractures without formal medical qualification - treat an estimated 10% - 85% of fracture patients in low- and middle-income countries (LMICs). Children are disproportionately vulnerable due to physeal immaturity and lower diastolic blood pressure thresholds that increase susceptibility to compartment syndrome at lower absolute intracompartmental pressures than in adults. No prior systematic review has restricted analysis exclusively to the paediatric population or generated pooled meta-analytic estimates of complication rates. This protocol describes a systematic review and meta-analysis to determine the pooled incidence of paediatric TBS-related complications across LMICs. Methods and analysis Nine databases will be searched (PubMed/MEDLINE, Embase, Cochrane CENTRAL, African Index Medicus, Global Health/CABI, Scopus, LILACS, WHO ICTRP and the COSECSA Archive) supplemented by grey literature sources, using three complementary PubMed search strings and 15 verified vernacular synonyms for TBS practitioners (including Wegesha, Onisegun, Rebouteux, Huesero and Vaidya). Database searching commenced in April 2026 and is currently in progress. No screening, data extraction or analysis has been initiated. Eligibility requirements: children aged Primary outcomes are: major limb amputation, bonesetter's gangrene, Volkmann's Ischaemic Contracture (VIC) and sepsis-related mortality. Risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS), MinCir scale and Mixed Methods Appraisal Tool (MMAT). Pooled complication proportions will be calculated using the Freeman-Tukey double arcsine transformation under a random-effects model (DerSimonian-Laird and REML). Lag time from injury to hospital presentation will be examined as a continuous moderator in meta-regression, and the certainty of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. Ethics and dissemination No primary data are collected; formal ethics approval is not required. Findings will be disseminated through peer-reviewed publication and presentation at relevant orthopaedic and global surgery conferences. If pooled paediatric amputation rates exceed 30% in late-presenting patients, findings will additionally be submitted as a formal evidence brief to the WHO Global Surgery Programme, the College of Surgeons of East, Central and Southern Africa Global Surgery Commission, and national orthopaedic associations in Nigeria, Ghana, Ethiopia and Pakistan. This protocol is registered with PROSPERO (CRD420261349595). 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