The rate of nonunion of shaft of humerus ranges from 0 to 15%. The management of this problem becomes difficult when it is complicated by osteoprosis, bone defects and previous surgeries. We treated 24 such cases. There were sixteen males and 8 females. Age ranged from 28 to 65 years and averaged 46 years. Ten fractures were in the middle third and 14 were at the junction of middle and lower thirds. The average duration of nonunion was 8 months. Eight cases were previously treated with plating, 4 were treated with intramedullary nail and 2 with external fixator. Ten cases were treated with slab or cast. All cases were treated with removal of old metalwork (if any), open reduction, placement of fibula autograft in the medullary canal of humerus, plating and cancellous onlay grafting. The length of the fibula autograft in the humerus exceeded the plate length over each fragment. Anterior approach was used in 22 cases. In 2 cases posterior approach was used because of a previously posterior placed plate. U-slab was given in the postoperative period. It was discarded when there was clinical and radiological evidence of union. Physiotherapy was given to all patients after union. 22 humeri united and 2 failed to unite. 21 patients could carry out their daily activities and return to their profession. There was no postoperative radial nerve palsy. 1 case had fibula donor site pain. The follow-up period was 12 to 26 months and averaged 20 months.
We report the results of the treatment of 23 patients with macrodactyly. Eighteen had a two-stage bulk-reducing (defatting) procedure; phalangectomy was used to shorten the digits. At a mean follow-up of nine years (2 to 12), two patients had been lost to follow-up, and three await a second-stage procedure. Good cosmetic correction was achieved in 12 patients, with satisfactory results in seven; two patients had poor results and required amputation.
