Extensive muscle necrosis leading to hip disarticulation after bone setting and live-toad application: a case report

Introduction and importance: Traditional bone-setting remains commonly sought for musculoskeletal injuries in low- and middle-income countries. However, unsafe practices may lead to severe limb- and life-threatening complications. Additionally, some products used in traditional treatments introduce potential toxicological risks and could adversely affect clinical outcomes. Case presentation: A 24-year-old man sustained a closed left lower-leg injury initially managed with bone setting, including repeated topical treatments and subsequent application of secretions from a live toad. He sought traditional care due to cultural familiarity, accessibility, and perceived effectiveness. Plain radiographs revealed a nondisplaced midshaft tibial fracture. The patient subsequently developed progressive muscle necrosis and soft-tissue infection, requiring multiple surgical debridements, above-the-knee amputation, and ultimately hip disarticulation. At the 3-year follow-up, he achieved good functional outcomes using a full-limb prosthesis. Clinical discussion: The catastrophic progression in this patient was likely multifactorial, involving repeated traditional interventions, an unusual transcutaneous exposure to toad secretions, delayed access to formal healthcare, and progressive soft-tissue infection. This case highlights the risks associated with traditional fracture care and the importance of early recognition of warning signs, timely referral, and communication between traditional practitioners and formal care services. Conclusion: Certain traditional fracture-care practices can have severe consequences. Collaboration with formal healthcare systems and the avoidance of unsafe practices are essential to prevent limb- and life-threatening complications.