Why Do Millions Still Choose Bonesetters?

By Eswar Kumar · 9 August 2026

People choose bonesetters because, in the places where the tradition survives, the bonesetter is usually cheaper, nearer, quicker and more familiar than the hospital — and because the hospital frightens them. Patronage studies from India, Nigeria, Ghana and Tanzania keep returning the same short list of reasons: cost, access, fear of plaster and surgery and amputation, the recommendation of someone already trusted, and shared culture or faith.

This article sets out what those studies actually found. It explains the choice; it does not recommend it. Several of the papers quoted below for their patronage figures are the same papers that document limbs lost, and the honest version of this subject holds both facts at once. If you want the evidence on outcomes rather than motives, that is a separate question, covered in Is bonesetting safe?

The numbers

Start with the least reliable number, because it is the one most repeated. Nobody knows how many traditional bonesetters practise in India. The 2011 study of the Puttur tradition in the Journal of Ayurveda and Integrative Medicine mentions “nearly 6000 traditional bone setting Vaidyas.” A 2022 case series in the Kansas Journal of Medicine puts it at “approximately 60,000… who have no formal education or training in modern medicine but treat approximately 60% of bone related trauma.” Those estimates differ by more than an order of magnitude, and no census stands behind either. The widely quoted “60% of bone trauma” is one research group’s estimate, not a measurement.

Local volume is better documented: the same Puttur study recorded the family’s clinics in Rachapalem village drawing “a minimum of 200–300 patients per day,” and interviewed 146 patients, following 52 to the end of treatment. Population surveys give a firmer sense of reach in West Africa. A 2013 survey of 400 residents of Ilorin, north-central Nigeria, in the Journal of Preventive Medicine and Hygiene, found 77.3% knew of bonesetting and 52.3% had used it at some point. A 2024 study of 420 heads of households in Abakaliki, south-east Nigeria, in the Pan African Medical Journal, found 79.3% had heard of traditional bonesetters, 33.3% had used one, and 32.4% would be willing to in future.

The counterexample matters just as much. A 2021 survey of 212 orthopaedic outpatients at Kilimanjaro Christian Medical Centre in Moshi, northern Tanzania, in African Health Sciences, found only 6.3% had used a bonesetter before arriving, 89.1% would not use one in future and 90.7% would not recommend one. Patronage is not a uniform feature of the global South; it varies sharply by country, by region, and by which door the researcher stands in. The backdrop is broader than any of it: the World Health Organization reported in 2023 that 170 of its 194 Member States have reported on the use of traditional medicines, and that for millions in remote and rural areas traditional medicine “continues to be the first port of call for health and well-being.”

Cost and access

Money is the most consistently reported reason, and the figures are startlingly small. The 2011 Puttur paper recorded a registration charge of ₹15, materials at ₹10 to ₹30, and a closing fee of ₹50 to ₹100, with consultation free for poor patients. The 2022 Kansas Journal of Medicine case series found practitioners who often charged nothing at all and supported themselves by farming.

In several of the Nigerian and Ghanaian surveys, cost leads. In Ilorin, among respondents who thought bonesetting preferable to orthodox care, 63.8% said it was cheap and 51.9% said it was accessible. In Abakaliki, 51.0% named cheap or affordable treatment as the general reason people go, and 45.6% of those willing to use a bonesetter in future cited reduced cost. A 2021 mixed-methods study of 64 bonesetter clients in Ghana’s Northern Region, in the African Journal of Emergency Medicine, found “cheaper fees” the leading reason at 26.3%, with “quick service” at 15.9%.

These preferences sit inside a wider affordability problem. WHO Global Health Expenditure Database figures compiled by the World Bank show out-of-pocket payments still accounting for 43.9% of India’s current health expenditure in 2023 — down sharply from 63.2% in 2016, but still close to half of every rupee spent on health coming straight from households. The Lancet Commission on Global Surgery estimated in 2015 that five billion people lack access to safe, affordable surgical and anaesthesia care, that in low-income and lower-middle-income countries as many as nine in ten cannot access basic surgical care, and that a quarter of people who undergo surgery face financial catastrophe as a result.

Access is not only about price. Reporting on the 2022–23 edition of Health Dynamics of India — the Ministry of Health and Family Welfare publication formerly called Rural Health Statistics — put the shortfall of specialists at rural community health centres at roughly 80%, and of surgeons specifically at over 80%. Waiting is a cost too: in Ilorin, 71.0% named delay in hospitals as a factor and 77.5% named the attitude of health workers.

Fear: plaster, surgery, amputation

Fear is the second theme, and it is specific rather than vague. The 2011 Puttur survey found that 44% of patients “opted for this therapy due to fear of pain, heavy plaster of Paris bandage, prolonged period of immobilization, surgery and amputation.” The Ilorin survey found fear of amputation named by 68.0% of respondents and fear of an operation by 54.3%. In Abakaliki, 11.8% of those willing to use a bonesetter gave avoiding amputation as their reason.

Fear also pulls people out of hospitals mid-treatment: the Puttur study recorded that 23% of the cases it observed “took discharge from modern hospital voluntarily” to go to the bonesetter instead.

The bitter irony is documented in the same literature. A study of 100 major amputations performed on 96 patients across two Nigerian regional hospitals over ten years, published in Tropical Doctor in 2000, found trauma the leading indication for 70 of them — and of those 70, 60 were iatrogenic, resulting from fractures mismanaged by traditional bonesetters. Fear of amputation is, in a documented number of cases, one of the reasons people end up on the pathway that leads to one.

Trust and word of mouth

The single largest driver in the Indian data is not money. It is the recommendation of someone who went before. The 2011 Puttur survey found 54% of patients came “on the advice of old patients,” and 55% said former patients were how they had heard of the centre at all. In Ilorin, the main reason given was “influence from family members and friends” at 53.6%.

A 2016 prospective study of 79 fracture patients at a Nigerian orthopaedic outpatient clinic, in the Nigerian Journal of Surgery, upends the usual assumption. Its largest category was an external locus of decision-making — someone other than the patient chose — at 24.1%. Greater faith in bonesetters than in conventional medicine accounted for 20.3%, a belief that bonesetters were more competent for 15.2%, and lower cost for only 13.9%. The authors attribute patronage to patients’ “dependence… on their sponsors for treatment” plus cultural and religious influence. In that clinic, cost was the fourth reason, not the first.

Trust runs the other way too. Asked why they would not use a bonesetter, the Tanzanian patients most often named lack of competency or quality of care (35.8%), then trust or belief in the care (17.6%), then equipment and diagnostic resources (13.4%). The same currency — confidence in the person holding the limb — explains both the going and the not going.

The faith dimension

Bonesetting is frequently embedded in religious frameworks, and researchers report this as part of the practice rather than decoration around it. The Ghanaian study in the Northern Region listed “cultural beliefs” as the second most-cited reason at 17.9%, and its focus groups found participants valued bonesetters attending to physical and spiritual dimensions of an injury. A companion 2020 study of 28 Ghanaian bonesetters in the Pan African Medical Journal recorded that their treatments included “reasonable versions of closed reduction and immobilization, but also use of locally-derived concoctions and spiritual aspects.” In Kashmir, Reuters reported in October 2025 that bonesetting there “typically involves massaging the affected area, wrapping it with cloth or medical tape, and reciting holy verses,” and that many patients believe bonesetters possess a spiritual healing touch — a tradition covered separately in Kashmir’s bonesetters.

Lineage carries its own authority. Transmission within families over generations — the defining feature described in What is Indian bonesetting? and traced in the history of Puttur kattu — means the practitioner is often a known figure with a known ancestry, in a place where the hospital consultant is a stranger. Among the Ghanaian practitioners surveyed, 85.7% had learned their skills from older family members and 67.9% had no formal education.

Describing this is not endorsing it. A belief held sincerely, for generations, by a whole community says a great deal about the community and nothing at all about whether a particular fracture will unite.

What this means for patient safety

Every reason above is real, and several are entirely rational responses to a health system that has failed the person making the choice. None of them changes what happens to a badly managed fracture. Here is the countervailing evidence, from the same body of literature.

A 2020 retrospective study of 362 patients who reached an Indian tertiary hospital after treatment by traditional bonesetters, in the Indian Journal of Orthopaedics Surgery, recorded malunion in 36.74%, nonunion in 19.06%, joint stiffness in 16.02%, compartment syndrome in 5.80% and gangrene in 2.48%. That is a selected population — a hospital only sees the cases that went wrong — so it is not a complication rate for the practice as a whole. It does establish the range of what can go wrong.

Three structural findings compound it. Diagnosis without imaging: the 2011 Puttur paper records that X-rays “are given less importance” and that the campus has no X-ray unit. Referral gaps: of the 28 Ghanaian practitioners surveyed, only 21.4% regularly referred complications to hospital. Delayed escape: among Tanzanian patients who had switched from a bonesetter to hospital care, 54.5% did so because the injury was not improving or was worsening — the switch came after time had already been lost.

Seek qualified medical care immediately — do not go to a bonesetter first — if any of these apply:

  • Suspected fracture — visible deformity, inability to bear weight, a crack or snap at the moment of injury, severe pain over a bone.
  • Suspected or visible dislocation — a joint that is locked, misshapen or cannot be moved.
  • Any acute trauma — road accidents, falls from height, crush injuries, blows to the head, neck or spine.
  • Numbness, tingling, weakness or loss of function in a limb, hand or foot.
  • A limb that is cold, pale, blue or pulseless, or pain that keeps escalating — possible compartment syndrome or vascular compromise. Both are surgical emergencies, and both are among the documented pathways to amputation.
  • A splint or binding that becomes tight, or swelling under a dressing — loosen nothing and guess nothing; get it looked at.
  • Open wounds, bone visible through skin, fever or spreading redness — infection risk.
  • Loss of bladder or bowel control, or severe progressive back pain — a spinal emergency.
  • You are not sure. Uncertainty is itself a reason to be examined.

Fractures and dislocations need imaging and a clinician. Cost and distance are genuine barriers, and pretending otherwise would be dishonest — but a delayed presentation is the mechanism behind most of the worst outcomes in the studies above.

What health systems are trying

The response with the most evidence behind it is neither prohibition nor endorsement. It is training, and it has been formally tested.

A prospective study in the South African Medical Journal in 2006 compared one Nigerian bonesetter given a one-day instructional course with an untrained bonesetter at a control centre, both treating tibial shaft fractures between 2002 and 2004. The trained practitioner’s patients had gangrene in 2.5% of cases against 10%, infection in 5% against 12.5%, non-union in 7.5% against 15% and malunion in 20.0% against 30% — differences the author reported as statistically significant. That is two practitioners, not a population, and it says nothing about whether bonesetting works. It says harm fell when knowledge rose.

The largest formal attempt to date is Ghanaian. A proof-of-concept study in the Journal of Bone and Joint Surgery in December 2023 reported that 157 traditional bonesetters across four Ghanaian regions completed a four-day course in basic fracture-care principles, run in five sessions during 2021. Knowledge scores rose from 67.2% to 86.9%, a gain of 19.7%; at six months the most improved practices were record-keeping, hand hygiene and patient rehabilitation; and the referral system the project established sent 37 patients to local hospitals in that window.

Willingness is not the obstacle. In the 2020 Ghanaian survey, all 28 practitioners endorsed the advantages of orthodox care — X-rays and record-keeping at 100%, pain management at 85.7% — and 96.4% wanted training or other engagement with the formal health sector. The Tanzanian authors reached a similar conclusion from the patient side: collaboration through a formal referral system “could expand allopathic access to these patients.”

India, so far as the published record shows, has no comparable bonesetter-specific training or referral programme. The government’s integration effort runs through AYUSH — codified systems such as Ayurveda, with their own colleges and registers — which is a different thing from the unregistered family lineages this article is about. That gap is worth stating plainly rather than filling with speculation.

Frequently asked questions

Why do people go to bonesetters instead of hospitals?

Published patronage studies converge on five reasons: lower cost, easier access, fear of plaster casts, surgery and amputation, the recommendation of family or previous patients, and shared cultural or religious framing. Their relative weight varies by place — a 2011 Indian study found word of mouth first at 54%, and a 2013 Nigerian survey likewise found influence of family and friends first at 53.6% — though among the Nigerians who already preferred bonesetters, cheapness led their reasons at 63.8%.

Is bonesetting cheaper than hospital treatment?

Usually, and by a wide margin — though price is not an outcome measure. The 2011 study of the Puttur tradition in Andhra Pradesh recorded a ₹15 registration fee, ₹10–30 for materials and a closing charge of ₹50–100, with consultation free for poor patients. A 2022 case series in South India found practitioners who charged nothing and farmed for a living.

How many people in India use traditional bonesetters?

Nobody has counted. Estimates of practitioner numbers range from “nearly 6000” in a 2011 paper to “approximately 60,000” in a 2022 one, and the frequently quoted claim that they treat around 60% of bone trauma in India comes from that 2022 estimate rather than from any national dataset.

Do patients regret choosing a bonesetter?

The published data cuts both ways and neither figure is an outcome measure. The 2011 Puttur study reported 71% satisfaction among the 52 patients it followed to the end of treatment. Among Tanzanian orthopaedic outpatients who had switched from a bonesetter to hospital care, 54.5% switched because the injury was not improving or was worsening.

Can traditional bonesetters be trained to be safer?

There is real evidence that training reduces harm, though not that it makes bonesetting effective. A 2023 Ghanaian proof-of-concept study trained 157 bonesetters over four days and recorded a 19.7% knowledge gain plus 37 hospital referrals in the following six months; a small 2006 Nigerian comparison found lower gangrene, infection, non-union and malunion rates for a trained practitioner than an untrained one.

Does explaining why people choose bonesetters mean it is a reasonable choice?

No. Understanding a decision and endorsing it are separate acts. The reasons documented here are often rational given the alternatives available to the person, and the complications documented in the same literature — including limb loss — are equally real. A suspected fracture or dislocation needs imaging and a clinician.

Sources

This article is educational and is not medical advice. It describes why people choose traditional bonesetters; it does not recommend that anyone do so. Suspected fractures and dislocations need imaging and a qualified clinician.