A 35-year-old sustains a tibial shaft fracture treated with intramedullary nailing. At 9 months, the fracture line remains visible with minimal callus and the patient has persistent pain. Plain radiographs show sclerotic fracture ends with a sealed medullary canal. This is best classified as:

• A Hypertrophic non-union (elephant foot)
• B Atrophic non-union ✓
• C Oligotrophic non-union
• D Infected non-union requiring two-stage treatment

Explanation

Weber and Cech classified non-unions based on biological activity. Atrophic non-union shows absent callus, sclerotic bone ends, sealed medullary canals, and no radiological signs of bone healing activity — indicating failure of the biological (osteogenic) response. This is in contrast to hypertrophic (elephant foot) non-union, which shows abundant callus indicating adequate vascularity but mechanical instability. Atrophic non-union requires biological augmentation (autologous bone graft, BMPs, periosteal stripping) combined with stable fixation. Oligotrophic (C) has minimal callus with some vascularity but displaced fragments.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.