Abstract

Traditional bone setters (TBS) remain important musculoskeletal care providers across West Africa. Their role is 
well documented for fractures, dislocations, and soft-tissue injuries, but their effectiveness in treating chronic 
degenerative conditions such as osteoarthritis (OA) and inflammatory arthritis is far less clear. This review 
synthesizes the available literature on TBS practice in West Africa, examines reported outcomes and complications, 
explores reasons for continued patronage, and identifies gaps in evidence specifically regarding arthritis care. 
Published studies and reviews consistently report that TBS are widely used because of accessibility, lower cost, 
cultural acceptability, and perceived efficacy; however, most rigorous research focuses on acute trauma (fractures) 
rather than chronic joint disease. Observational and hospital-based series document substantial rates of 
complications (malunion, non-union, gangrene, chronic osteomyelitis) when TBS manages complex fractures, and 
expert statements call for improved engagement, training, and integration to reduce avoidable harm. There is a 
notable absence of controlled trials or longitudinal studies assessing clinical outcomes of TBS treatments for OA 
(pain, function, radiographic progression) or inflammatory arthritis; most evidence is anecdotal or derived from 
patient surveys. We conclude that while TBS may provide symptomatic relief and psychosocial benefits to some 
arthritis patients, there is insufficient high-quality evidence to support their effectiveness in modifying disease or 
reliably improving long-term function. Research priorities include prospective outcome studies for arthritis patients 
treated by TBS, implementation research on collaborative models with orthodox care, and culturally informed 
strategies to enhance referral pathways and patient safety