Bone setter's gangrene.

Background/purpose: Little published data exist on the morbidity and mortality associated with poor trauma care in developing countries. This report highlights our experience with iatrogenic limb gangrene related to fracture management by traditional bone setters.

Methods: Children with "bone setter's" gangrene were identified from a prospectively recorded pediatric surgery database at the Royal Victoria Hospital in Banjul, The Gambia--the main government referral hospital.

Results: Nine children were treated for bone setter's gangrene during a 29-month period. The average age was 8.2 years (range, 5 to 14 years). Bone setter's gangrene was more common in boys (male to female ratio, 2:1) and occurred almost exclusively (89%) in children from rural areas where access to health care was limited. Five children (56%) underwent proximal extremity amputations. Complications included 1 death related to sepsis, a case of chronic osteomyelitis at an amputation site, and a contracted insensate hand in a child whose parents refused amputation.

Conclusions: Bonesetter's gangrene is a preventable complication that results from a failure of child health planners to recognize the importance of basic trauma care. Management of fractures should be considered an essential component of child health programs in developing countries.