Unadkat Aayush, Stoller Emily, Pine Haleigh, Eisner Zachary J, Klapow Maxwell C, Kulkarni Ashwin J, Thiagarajan Anagha, Smith Nathanael, Delaney Peter G
University of Michigan Medical School, Ann Arbor, Michigan, USA.
LFR International, Los Angeles, California, USA.
World J Surg. 2025 Aug;49(8):2255-2263. doi: 10.1002/wjs.12678. Epub 2025 Jul 11.
Low- and middle-income countries (LMICs) experience the highest rates of injury-related deaths globally, exacerbated by a lack of robust emergency medical services (EMS). Though fractures contribute substantially to global injury, little is known about prehospital management of extremity fractures in LMICs.
This review included literature published between January 2000 and January 2024. Inclusion criteria pertained to prehospital settings, defined as care rendered prior to hospital presentation, including care provided by lay first responders (LFRs), professional EMS personnel, and traditional bonesetters (TBS). Multiple authors used the Newcastle-Ottawa scale to assess texts meeting inclusion criteria, extracting relevant details for analysis.
Of 1251 articles identified, 25 met inclusion criteria. Studies spanned 9 countries across 4 continents, with 14 articles studying care by TBS, 9 by LFRs, and 2 by other prehospital providers. LFR training courses report a combined weighted average pre-/post-course difference of 29.16 percentage points. A total of 67% of included studies report adverse outcomes associated with TBS-managed fractures in the prehospital setting. TBS care is often sought prior to hospital presentation due to sociocultural beliefs, accessibility, and cheaper costs. Few training courses for TBS have been performed, though one course reports a 20.4% increase in fracture management knowledge.
In certain resource-limited settings, TBS provide most initial fracture management, which may adversely impact outcomes. Knowledge transfer has been demonstrated during prehospital fracture management courses for LFRs and TBS. Early evidence suggests TBS training and integration into healthcare systems may reduce complication rates, improving long-term outcomes.
低收入和中等收入国家（LMICs）在全球范围内与伤害相关的死亡率最高，而缺乏强大的紧急医疗服务（EMS）使这一情况更加恶化。尽管骨折在全球伤害中占很大比例，但对于LMICs中肢体骨折的院前管理知之甚少。
本综述纳入了2000年1月至2024年1月发表的文献。纳入标准涉及院前环境，定义为在医院就诊之前提供的护理，包括由非专业急救人员（LFRs）、专业EMS人员和传统接骨师（TBS）提供的护理。多位作者使用纽卡斯尔-渥太华量表评估符合纳入标准的文本，提取相关细节进行分析。
在识别出的1251篇文章中，25篇符合纳入标准。研究涵盖4大洲的9个国家，其中14篇文章研究了TBS的护理，9篇研究了LFRs的护理，2篇研究了其他院前提供者的护理。LFR培训课程报告课程前后综合加权平均差异为29.16个百分点。总共67%的纳入研究报告了院前环境中TBS管理骨折的不良后果。由于社会文化信仰、可及性和成本较低，在医院就诊之前人们通常会寻求TBS的护理。针对TBS开展的培训课程很少，不过有一个课程报告骨折管理知识增加了20.4%。
在某些资源有限的环境中，TBS提供了大多数初始骨折管理，这可能会对结果产生不利影响。在LFRs和TBS的院前骨折管理课程中已证明知识转移。早期证据表明，TBS培训并将其纳入医疗保健系统可能会降低并发症发生率，改善长期结果。
