Complications of traditional bonesetting in contemporary fracture care in low- and middle-income countries: A systematic review.

OBJECTIVE: To provide an overview of the evidence on the prevalence and pattern of complications among patients treated by traditional bonesetting presenting for modern orthopaedic services in low- and middle-income countries (LMIC). METHODS: Systematic review following PRISMA guidelines. Articles were identified by searching PubMed, Embase, ScienceDirect, SCOPUS, and Web of Science using the keywords "fracture care", "traditional bonesetters" and "complications". Papers included for review were original articles set in an LMIC that directly reported the prevalence and pattern of musculoskeletal complications of traditional bonesetters' fracture treatment in LMIC settings. RESULTS: A total of 176 papers were screened for eligibility and 15 studies were finally included. Nine were prospective studies, six were retrospective studies. All were hospital-based, observational studies that investigated the outcomes of treatment of fractures by traditional bonesetters published between 1986 and 2018. In total, this review covers 1389 participants with 1470 complications of fracture treatment. CONCLUSION: Traditional bonesetting complications are associated with significant morbidity. However, traditional bonesetters have the potential to contribute positively to primary fracture care when they are trained.

Endonasal Infiltrative Anesthesia for Nasal Fracture Reduction.

This study investigated the use of endonasal infiltrative anesthesia for the management of pain associated with nasal bone fracture reduction. Fifty-two patients with nasal bone fractures were distributed in 2 groups. In the first group, topical endonasal anesthesia and external transcutaneous infiltrative anesthesia were employed. In the second group, endonasal infiltrative anesthesia was also added. Visual analog scale pain scores related to the different steps of the procedure were registered. The addition of endonasal infiltrative anesthesia was associated with a significant decrease (p < .05) in pain during reduction maneuvers (6.71 vs. 4.83) and nasal packing (5.18 vs. 3.46). Addition of endonasal infiltrative anesthesia is an effective method of pain reduction during nasal bone fracture treatment.

Nonoperative manipulative reduction with Chinese herbs for the treatment of a displaced olecranon fracture: A case report.

RATIONALE: Displaced olecranon fracture is a common injury following a fall or direct trauma to the elbow. There have been no reports of patients with a displaced olecranon fracture who have only received nonoperative manipulative reduction with Chinese herbs. PATIENT CONCERNS: The patient was a 64-year-old woman with a complex elbow injury that occurred in a traffic accident. The patient complained of severe, painful limitation of motion on straightening or bending. DIAGNOSES: The patient was diagnosed with a displaced fracture of the left olecranon (type IIA olecranon fracture according to the Mayo classification system). INTERVENTIONS: The patient underwent nonoperative manipulation with Chinese herbs. OUTCOMES: The fracture was successfully reduced. After 3 to 4 months of follow-up, severe pain and disability in the elbow were improved following reduction of the left olecranon fracture in which there was no longer a displacement. LESSONS: Nonoperative manipulative reduction performed by a well-trained physician with Chinese herbs may be a treatment option for displaced olecranon fractures.

[Application of convolute manipulation for the treatment of femoral fractures in children].

OBJECTIVE: To discuss the application of convoluted manipulation in pediatric femoral fractures. METHODS: From March 2015 to October 2016, 12 children with femoral fractures were treated by Chinese traditional manipulation including 8 males and 4 females with an average age of 6 years old ranging from 1 to 12 years old. The causes of injury were falls in 10 cases and traffic accidents in 2 cases. Of which 1 case was transverse fractures, 4 cases were oblique fractures and 4 cases were spiral fractures, 2 cases were comminuted fracture, 1 case was greenstick fracture. All patients underwent manual reduction within 1 to 2 days, plus small splint with cedar bark, and parallel lower limb traction. RESULTS: All the 12 patients were followed up for 1-3 months, with an average of 2 months. All the 12 patients achieved clinical union, and the average healing time was 6 weeks. There was no obvious shortening and rotational angulation. At the last follow-up, Schatzker-Lambert distal femoral fracture evaluation results were excellent in 11 cases, good in 1 case. CONCLUSIONS: Convoluted manipulation is very important for reduction of femoral fractures in children, with the splint of cedar bark, satisfactory therapeutic effect can be achieved.

Reducción de fracturas nasales con anestesia local. Nuestra experiencia / Reduction of nasal fracture with local anesthesia. Our experience / Redução de fratura nasal com anestesia local. A nossa experiência

Introducción: las fracturas nasales son la consecuencia más frecuente de los traumatismos craneofaciales. Su tratamiento puede involucrar una reducción cerrada de huesos propios nasales que puede realizarse con anestesia local. El objetivo del presente trabajo es evaluar los resultados funcionales, estéticos y el dolor en la reducción cerrada de fracturas nasales. Material y método: Estudio prospectivo, randomizado, y descriptivo que evaluó la funcionalidad nasal antes y después de la reducción, en dolor del procedimiento, y sus resultados estéticos. Resultados: Se realizaron un total de 21 reducciones cerradas. El signo más habitual fue la crepitación en 14 pacientes, laterorrinia en 13, y 4 epistaxis. En cuanto a ventilación nasal previo a la reducción, el máximo puntaje en la escala Nasal Obstruction Symptoms Scale fue de 13 puntos, con un promedio de 4,8 puntos; y luego de realizar la reducción nasal el puntaje más alto fue de 7, con un promedio de 1,09 puntos. Estéticamente, luego de realizar la reducción nasal 8 pacientes notaron que su nariz estaba "mucho mejor", 9 pacientes notaron que su nariz estaba "mejor", y 4 pacientes indicaron que estaba igual. En cuanto a eficacia anestésica el menor puntaje fue de 0 referido por tres pacientes, el más alto fue de 10 en 2 pacientes; y el puntaje promedio referido fue de 3,5. Conclusiones: La reducción cerrada de fractura nasal es una técnica que es posible de realizar bajo anestesia local, obteniendo óptimos resultados estéticos y funcionales, y siendo bien tolerada por el paciente si la técnica se hace adecuadamente. Es necesario contar con la experiencia y los medios necesarios para realizarla.

Introduction: nasal fractures are the most frequent consequence of craniofacial trauma. Its treatment may involve a closed reduction of nasal bones that can be performed under local anesthesia. The objective of the present study is to evaluate the functional, aesthetic and pain outcomes in the closed reduction of nasal fractures. Material and method: Prospective, randomized, and descriptive study, evaluating nasal function before and after reduction, the pain of the procedure, and its aesthetic results. Results: A total of 21 nasal fracture reduction were made closed. The most common sign was crepitus in 14 patients, laterorrinia in 13, and 4 epistaxis. As for nasal ventilation prior to reduction, the maximum score in the Nasal Obstruction Symptoms Scale was 13 points, with an average of 4.8 points; and after performing the nasal reduction the highest score was 7, with an average of 1.09 points. Aesthetically, after making the nasal reduction 8 patients noticed that his nose was "much better", 9 patients noticed that his nose was "better", and 4 patients indicated that was “same as before”. As for anesthetic efficacy was the lowest score of 0 was reported by three patients, the highest was 10 in 2 patients; and referred the average score was 3.5. Conclusions: Closed reduction of nasal fracture is a technique that can perform under local anesthesia, obtaining optimal aesthetic and functional results, and being well tolerated by the patient if the technique is done properly. You must have the experience and resources needed to perform it.

Introdução: as fraturas nasais são a consequência mais frequente dos traumas craniofaciais. Seu tratamento pode envolver uma redução fechada de ossos próprios nasais, a qual pode ser realizada com anestesia local. O objectivo deste estudo foi avaliar o resultado funcional, estética e a dor na redução de fracturas fechadas nasais. Material e método: Estudo prospectivo, randomizado e descritivo que avaliou a funcionalidade nasal antes e depois da redução, a dor do procedimento e seus resultados estéticos. Resultados: Foram realizadas 21 reduções fechadas. O sinal mais comum foi a crepitação em 14 pacientes, laterorrinia em 13 e epistaxe em 4. No tocante à ventilação nasal antes da redução, o valor máximo na escala Nasal Obstruction Symptoms Scale foi 13 pontos, com uma média de 4,8 pontos; e, após a redução nasal, o valor mais alto foi 7, com uma média de 1,09 pontos. Esteticamente, após a redução nasal, 8 pacientes notaram que seu nariz estava "muito melhor"; 9 pacientes notaram que seu nariz estava "melhor" y 4 pacientes disseram que estava igual. A respeito da eficácia anestésica, o menor valor foi 0 segundo três pacientes, e o maior foi 10 em 2 pacientes. O valor médio comentado foi 3,5. Conclusões: A redução fechada de fratura nasal é uma técnica que pode ser realizada sob anestesia local, com ótimos resultados estéticos e funcionais. É bem tolerada pelo paciente se a técnica é realizada adequadamente. É preciso contar com a experiência e os meios necessários para realizá-la.