Complications des traitements traditionnels des traumatismes des membres au CHU Le Bon Samaritain de Walia (N’Djamena, Tchad)

INTRODUCTION: Traditional treatment of limb trauma by traditional healers is ubiquitous in Sub-Saharan Africa. These practices are the source of many complications. This study aims to clarify the profile of these complications and to identify the factors favoring the consultation of traditional healers. MATERIAL AND METHODS: Descriptive and analytical study over 12 months, from February 1, 2018 to January 31, 2019, covering all the patients who consulted at the surgery department of the CHU Le Bon Samaritain in N’Djamena (CHUBS) for a complication of a fracture or dislocation of a limb treated by a traditional healer. Data collection was carried out using a pre-established questionnaire with an average follow-up of 14 months. RESULTS: Out of 144 patients, 47 (33%) suffered from at least one complication of fracture or dislocation following traditional treatment. Thirty-two were included in the survey. Their mean age was 23 years (range 10-61) and the sex ratio 2.6 in favor of men. The origin was mainly rural: pupils/students and farmers/breeders were the most represented. We identified individuals from all levels of education, mainly primary level. Road accidents were the most frequent (n = 20). The influence of the entourage (n = 14) was the first factor leading to the choice of traditional treatment. The wooden splint, which did not immobilize the proximal fracture joints, associated with the ischemic bandage causing the gangrene, was the first means of restraint (n = 15). The mean time between trauma and the start of traditional treatment was 8.5 hours. The mean time from traditional treatment to onset of complications was 106 days (range 1-302). The most common complications were swelling of the limbs, malunions, gangrene and pseudarthrosis. The initial lesion was a closed fracture in most cases (n = 22) with a predominance of the pelvic limbs (n = 22). Hospital management was surgical (n = 19) or orthopedic (n = 13). Therapeutic progress has been good, fairly good or bad regarding 24, 2 and 6 cases respectively. The solicitation of traditional healers is frequent in traumatology. The influence of social background and ease of access to traditional “doctors” were noted as determining factors in the choice of this kind of treatment. The consequences of this practice have various origin: insufficient immobilization not respecting the standards; intense and untimely massages causing severe pain, secondary displacements and abnormal consolidation. Another study extended to patients who satisfied or not with the result of traditional fracture treatment in addition to those who consulted for complications would be more representative. CONCLUSION: The complications of traditional treatments for traumatic limb injuries are serious. The training of the traditional healers on basic notions of immobilization and the recognition of signs of seriousness, their collaboration with health structures as well as free care in hospital services would make possible to reduce this phenomenon. The media and social networks should help to reach a large audience.