Cultural context: About traditional bone setters

In most countries, the practice of traditional bone setters is dominated by male practitioners. They typically lack formal education, with the practice often passed down through paternal lineage or apprenticeship with neighboring men1,2.

Traditional bone setting (TBS) is a widely practiced form of traditional medicine in various parts of the world. This practice continues to play a significant role in providing healthcare to many communities around the world3,4.

Did you know? 85% of patients with fractures in Nigeria are treated with TBS2, and in India, 60% of bone-related traumas are treated by over 60,000 TBS practitioners around the country6.

What does traditional bone setting involve?

TBS involves the manual manipulation of fractured or dislocated bones, often using a combination of fracture massage, splinting, reduction, and herbal remedies to promote healing and relieve pain7.

However, many less scientific and less safe variations of this practice exist. The well-documented life- and limb-threatening complications of seeking treatment from bonesetters include:

1 Malunion

2 Nonunion

3 Joint stiffness

4 Chronic osteomyelitis

5 Ischemia

6 Gangrene

Why patients choose TBS

Despite the risks, many patients still opt for TBS services, for many reasons8, including:

1 Low cost of treatment9

2 Impersonal or abusive treatment at hospital (dissatisfaction with modern medicine)10

3 Lack of awareness11

4 Fear of surgery and amputation

5 Cultural belief12,13

6 Perceived effectiveness of traditional methods14

7 More accessibility to the wider population15

8 Social pressure

9 Spiritual guidance16

Research about the practice of TBS and its use for musculoskeletal disorders among Nigerian rural dwellers shows that 69.4% of respondents indicate that they have (at some point) used the services of a traditional bone setter for musculoskeletal problems16.

Most stakeholders within the system of fracture treatment, see the potential benefits and challenges of intersectoral collaboration between traditional bonesetters and formal healthcare systems. Training and integration being commonly suggested resulting in beneficial effects on trainee knowledge and skills, as well as improved patient outcomes17.

Country/regionRural (%)Urban (%)
Nigeria70-951829-501
Ghana52-7811-
Kenyaup to 909-
Tanzania4011-
Ethiopia56,91129,911
North-Central Africaup to 855-

Prevalence of TBS-use

In addition, 16.9% of the users of TBS services reported it to be as effective as orthodox medicine. Massage (61.0%) and splinting (14.3%) were the most common forms of treatment by TBS received for musculoskeletal disorders.

Factors to consider when treating a patient

Looking for common ground between traditional and modern medicine can facilitate integration19. By providing structured training and stimulating collaboration, recent studies have shown promising results in improving patient outcomes and reducing complications.

Be aware that if an open fracture patient in a resource-limited setting enters the hospital, it is likely they:

1 Were sent to the hospital by a bonesetter

2 Are only planning on getting an X-ray

3 Plan on returning to the bonesetter

4 Fear judgment by the physician for this fact

5 Fear amputation of the affected limb if treated at the hospital

6 Fear metal implants, which are commonly believed to slow healing, cause chronic pain, and cause cancer

7 Fear abuse from nurses or doctors

8 Fear high treatment costs

It is important to address these common fears, to avoid the patient requesting early discharge, which could result in suboptimal treatment.

Take your time and discuss the following with the patient:

1 The exact diagnosis.

2 The goal: to avoid amputation of the limb.

3 The recommended treatment and what the treatment involves.

4 If treatment involves metal implants: address beliefs regarding slow healing, chronic pain, and cancer. Explain the possibility of removal of osteosynthesis materials.

5 The duration of hospital stay.

6 The duration until return to work.

7 The risk of complications.

8 The exact cost of treatment.

9 Whether the patient plans to consult, or has already consulted a TBS. If so, most patients appreciate communicating with the TBS to find common ground and a treatment plan that is acceptable to all parties.

It may be more desirable to accept a traditional bone setter providing traditional massage in the hospital ward, if that means the patient agrees to surgical treatment as well. 

Literature

  1. Onyemaechi, N. O., Itanyi, I. U., Ossai, P. O., & Ezeanolue, E. E. (2020). Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters. Human Resources For Health, 18(1). https://doi.org/10.1186/s12960-020-00468-w
  2. Omololu, A. B., Ogunlade, S. O., & Gopaldasani, V. K. (2008). The Practice of Traditional Bonesetting: Training Algorithm. Clinical Orthopaedics And Related Research, 466(10), 2392–2398. https://doi.org/10.1007/s11999-008-0371-8
  3. www.wisdomlib.org. (2025, 4 maart). Traditional bone setting: Significance and symbolism. https://www.wisdomlib.org/concept/traditional-bone-setting
  4. Endeshaw, B. A., Belay, W., Gete, A., Bogale, K. A., Wubeshet, B., Azene, A. G., Wassie, G. T., Aderaw, W., Teshome, B., Muluneh, A. G., & Demissie, B. A. (2023). Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia. BMC Complementary Medicine And Therapies, 23(1). https://doi.org/10.1186/s12906-023-03951-8
  5. Odatuwa-Omagbemi, D. O., Adiki, T. O., Elachi, C. I., & Bafor, A. (2018). Complications of traditional bone setters (TBS) treatment of musculoskeletal injuries: experience in a private setting in Warri, South-South Nigeria. Pan African Medical Journal, 30. https://doi.org/10.11604/pamj.2018.30.189.15730
  6. Isaacs-Pullins, S., Vaz, M., Murthy, H., Hughes, D., & Kallail, K. J. (2022). A Qualitative Study of Traditional Bone Setters in South India: A Case Series. Kansas Journal Of Medicine, 15(3), 394–402. https://doi.org/10.17161/kjm.vol15.18580
  7. Yoruba traditional bonesetters: the practice of orthopaedics in a primitive setting in Nigeria. (1980, 1 april). PubMed. https://pubmed.ncbi.nlm.nih.gov/7365837/
  8. Palo, N., Chandel, S. S., Malik, C., Shukla, A., Choudhary, G. N., & Mannan, V. (2023). Traditional Bonesetters clinics. Journal Of Orthopaedic Diseases And Traumatology, 6(2), 194–199. https://doi.org/10.4103/jodp.jodp_126_22
  9.  Ossai, E. N., Ezenwosu, I. L., Okoro, K. A., Eze, I. I., & Agu, C. (2024b). Predictors of willingness to patronize traditional bone setters: a cross-sectional study among heads of households in Abakaliki Metropolis, Southeast Nigeria. Pan African Medical Journal, 49. https://doi.org/10.11604/pamj.2024.49.106.36444
  10. Birhan, W., Giday, M., & Teklehaymanot, T. (2011). The contribution of traditional healers’ clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study. Journal Of Ethnobiology And Ethnomedicine, 7(1). https://doi.org/10.1186/1746-4269-7-39
  11. Seid, M. A., Walelgn, B., Sendekie, A. K., Walle, G. T., Geremew, M. A., Sahlu, M. H., Mekonen, S. A., & Abate, B. B. (2025). Utilization and associated factors of traditional bone setting service among patients with musculoskeletal injuries in Northeast Ethiopia. Frontiers in Rehabilitation Sciences, 6. https://doi.org/10.3389/fresc.2025.1484403
  12.  Dada, A., Yinusa, W., & Giwa, S. (2011, 1 juni). Review of the practice of traditional bone setting in Nigeria. https://pmc.ncbi.nlm.nih.gov/articles/PMC3158503/
  13. World Health Organization. (2019). WHO Global Report on Traditional and Complementary Medicine 2019. https://iris.who.int/bitstream/handle/10665/312342/9789241515436-eng.pdf?sequence=1
  14. Worku, N., Tewelde, T., Abdissa, B., & Merga, H. (2019). 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. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4643-z
  15. Birhan, W., Giday, M., & Teklehaymanot, T. (2011b). The contribution of traditional healers’ clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study. Journal Of Ethnobiology And Ethnomedicine, 7(1). https://doi.org/10.1186/1746-4269-7-39
  16. Mbada, C. E., Ojoawo, A. O., Owoola, S. O., Okonji, A. M., Odetunde, M. O., Adigwe, K. C., Makinde, M. O., Adegbemigun, O. D., Fasuyi, F. O., Idowu, O. A., & Fatoye, F. (2020). Knowledge and Attitude about the Practice of Traditional Bone Setters and Its Use for Musculoskeletal Disorders in Rural Areas in Nigeria. Middle East Journal Of Rehabilitation And Health Studies, 7(2). https://doi.org/10.5812/mejrh.99973
  17. Binnerts, J. J., Hendriks, T. C. C., Hussein, S., Bempong‐Ahun, N., Ibbotson, G. C., Harrison, W. J., Martin, C., Ranganathan, K., Ehsan, A. N., Chirangi, B. M., Edwards, M. J. R., & Hermans, E. (2025). Intersectoral Collaboration Between Traditional Bonesetters and Formal Healthcare: A Systematic Review on Past Initiatives and Stakeholder Perspectives. World Journal Of Surgery. https://doi.org/10.1002/wjs.12503
  18. Nwachukwu, B. U. (2011). Traditional Bonesetters and Contemporary Orthopaedic Fracture Care in a Developing Nation: Historical Aspects, Contemporary Status and Future Directions. The Open Orthopaedics Journal, 5(1), 20–26. https://doi.org/10.2174/1874325001105010020
  19. Shrivastava, G. (2025, 4 maart). Global Traditional Medicine Market Size & Forecast 2025-2032. Coherent Market Insights. https://www.coherentmarketinsights.com/industry-reports/global-traditional-medicine-market

Contributors

Joost Binnerts, Nienke Smits, Abeba Aleka Kebede

Experts: Pieter Haasnoot

Editors: Job Wernand, Pim Bongers, Eva Alkemade, Matthijs Botman, Renz Wierper.

Cultural context: About traditional bone setters

Primary Item (H2)Sub Item 1 (H3)
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