A catastrophic presentation of dead limb secondary to traditional bone setter's treatment in Sorong, West Papua: A case report

Abstract

Introduction Traditional bone setter's gangrene is a devastating complication arising from the practice of TBS with a prevalence of 4.29%, and most cases require amputation, which led to permanent disability. This case demonstrates a catastrophic presentation of the lower limb gangrene secondary to traditional bone setter's treatment. Case presentation A 39-year-old man with history of treatment by traditional bone setter presented with generalized pain with loss of the skin throughout the entire right lower leg, leaving soft and hard tissue exposed to the environment. His vital signs showed tachycardia and fever. Pulses were absent on the entire lower leg except for the femoral artery. The radiograph revealed gas density around the soft tissue suggestive of gas gangrene. After stabilization, an above-knee amputation was performed by the orthopedic surgeon. Discussion Traditional bone setter's gangrene is a significant contributor to amputations in many developing countries. The practice of scarification, massage with herbal concoctions and creams, and a tight splint may lead to infection, vascular compromise, compartment syndrome that may terminate in gangrene or death of the limb. This progressive limb-threatening infection emphasizing the importance of early recognition of compartment syndrome, adequate resuscitation or stabilization, and prompt and aggressive treatment. Conclusion This case highlights the menace of TBS activities and the dangers inherent in their practice. People who are misguided by false beliefs should be educated by public enlightenment. Appropriate legislation should be supplemented by the government to integrate traditional bone settings with the new orthopedic care services.