Bickler S W, Sanno-Duanda B
Department of Surgery, Royal Victoria Hospital, Banjul, The Gambia.
J Pediatr Surg. 2000 Oct;35(10):1431-3. doi: 10.1053/jpsu.2000.16406.
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.
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.
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.
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.
背景/目的：关于发展中国家创伤救治不力所导致的发病率和死亡率，鲜有公开数据。本报告重点介绍了我们在处理传统接骨师治疗骨折引发医源性肢体坏疽方面的经验。
从冈比亚班珠尔皇家维多利亚医院（该国主要的政府转诊医院）前瞻性记录的儿科手术数据库中，识别出患有“接骨师所致坏疽”的儿童。
在29个月期间，有9名儿童接受了接骨师所致坏疽的治疗。平均年龄为8.2岁（范围为5至14岁）。接骨师所致坏疽在男孩中更为常见（男女比例为2:1），几乎全部（89%）发生在医疗保健可及性有限的农村地区儿童中。5名儿童（56%）接受了近端肢体截肢手术。并发症包括1例因败血症死亡、1例截肢部位慢性骨髓炎以及1例因家长拒绝截肢而导致手部挛缩且感觉丧失的患儿。
接骨师所致坏疽是一种可预防的并发症，其原因是儿童健康规划者未能认识到基本创伤救治的重要性。骨折处理应被视为发展中国家儿童健康项目的一个重要组成部分。
