The results were www.selleckchem.com/products/AG-014699.html analyzed using Statistical Package for Social Science version 15. The association test was done using Chi square and the level of significance was p<0.05 RESULTS Twenty-two patients with humeral fracture nonunion were treated, representing 25.3% of all patients with humeral fractures seen in our hospital over the study period. The median age was 41.5 years with range of 23 to 76 years and male to female ratio of 1.8:1. The cause of injury was road traffic injury in 86.4% (19/22), fall 9.1% (2/22), and assault in 4.5% (1/22). The previous treatment was from traditional bone setters in 81.8% (18/22) patients and failed conservative treatment from other hospital in 18.2% (4/22). Atrophic nonunion occurred in 81.8% (18/22) and hypertrophic nonunion in 18.2 %(4/22) of the individuals (3/22).

Only 7.2% (6/22) had primary radial nerve injury. All fractures were closed. The complications were wound hematoma in one patient and superficial wound infection also in one patient. The superficial wound infection resolved with daily wound dressing and antibiotics administration and spontaneous resolution of the hematoma occurred without the need for surgical drainage. The fracture characteristics and surgical approach are as in Table 1. Table 1 Fracture characteristics and surgical approach The average time to union was 16 weeks. Those with previous treatment from traditional bone setters had time to union of 20 weeks, with a time of 12 weeks for those with failed conservative treatment. This was statistically significant at p<0.05.

(Table 2) The treatment by the traditional bone setter significantly affected the time to union after open reduction and internal fixation with narrow 4.5 mm dynamic compression plate. We followed the patients at two-week intervals in the first month and then every month for six months and once every two months for another six months. Table 2 Previous treatment and time to union DISCUSSION The treatment of nonunion humeral shaft fracture continues to pose a challenge to orthopedic surgeons especially in developing countries where recent advances in the care of this fracture may not be readily available. There has been documented evidence of the superiority of plating of humeral shaft nonunion as reported by Kontakis and associates in their systematic review of literature.

7 In this study the most common cause of injury was road traffic accident with male preponderance. This was not surprising since trauma has been described as an emerging epidemic in developing countries with the increasing use of automobiles.8 It was also observed that more than 80% of the patients in this study had previous treatment with traditional bone setters. The traditional Batimastat bone setters are alternative practitioners involved in the care of fractures. Their mode of treatment of fractures includes among others the use of local splints made from raffia palms and bamboo sticks.