Traditional bonesetters clinics: Prospective trends and work assessment on 915 bonesetters operating in parts of Uttar Pradesh and Haryana, India

Introduction: In India, majority patients with musculoskeletal injuries are attended by traditional medicine treatment provider. Bone setting services data from Subcontinent is not available. Methods: Prospective epidemiological study across 10 cities. Objective: To document bonesetter's spectrum of services and work-based information; radiological services use, treatment methods, treatment cost, treatment duration, referral timing, complication incidence and success rates. Results: Study encompasses 915 Traditional Bone Setters working over area of 6725 km2. Meerut houses most bonesetters (n=130); industry dominated by men (98.5%). 55% bonesetters are of 51-70 years. Overall experience 53.75 years. 9.50 % Bonesetters have radiograph machines. 55.95% practicing bonesetters are 3rd generation lineage. 32.67% bonesetters prescribe allopathic medications. For treatment, Males visit more (55%) followed by Females (25%) and Third gender (15%) patients. Patients age group 5-94 years. 22.4 patients visit each bonesetter daily. An average treatment lasts 4-5 sessions; treatment cost 300-400 Indian Rupees per sitting (3.60-4.80 USD). Patient report 2.75 days post injury & treatment lasts 14.5 days. 90% Bonesetters take time till 3rd bandage (9-10days) to decide on referral. Patient's satisfaction is 64% and 45% complication rates. Discussion: Traditional Bone Setters form largest specialised group offering services for musculoskeletal injuries in India; attracting 25-40 patients per practitioner daily. High complication and referral rates are worrisome. Conclusion: Clientele visiting bonesetters form major chunk of patients that should be treated by Orthopaedic Surgeons. Policies should be made to integrate bonesetters into structured health services; to benefit community at larger scale with fewer complications and man hours lost to work.