Delayed Union of a Distal Tibia–Fibula Fracture Following Traditional Bone Setter Management: A Case Report from Rural Uganda

Background: Among the most common fractures involving the long bones of the body are those occurring in the tibia, and they are often associated with substantial morbidity, especially in instances where healing takes a long time to occur. Delayed union has been recognized as a complication of fractures, and it has been attributed to improper stabilization of the fracture, late referral to a specialist, and improper treatment. In low- and middle-income countries, traditional bone setters (TBS) are often the first port of call for musculoskeletal injuries, and this has been linked to adverse outcomes in fractures. Case Presentation: A 28-year-old male was found to have a fractured tibia and fibula as a result of a football injury. The patient was first seen and treated by a TBS and presented to the orthopedic clinic three months later with pain, deformity, and inability to bear weight. He was found to have a fracture gap with minimal callus and cortical bone, indicating delayed union. The patient was taken to surgery, where an intramedullary nail was inserted to treat the fracture. At four weeks post-surgery, radiographs demonstrated early callus formation along the tibial cortex and maintenance of fracture alignment. Functionally, the patient tolerated partial weight-bearing with improved limb mobility and reduced pain. Conclusion: This case highlights the orthopedic and public health implications of delayed presentation after traditional fracture care and demonstrates that timely intramedullary nailing can achieve favorable early radiographic and functional outcomes. Early presentation to an orthopedic facility is crucial in avoiding complications in the management of fractures. Keywords: tibial fractures, intramedullary nailing, delayed union, traditional bone setter, fracture management