A 45-year-old undergoes intramedullary nailing of a diaphyseal tibial fracture. At 8 months, the fracture line is still clearly visible on radiograph and callus bridges the fracture at less than 25% of the cortical diameter. There is no pain or tenderness. The most appropriate next step is:

• A Exchange (reamed) intramedullary nailing
• B Continue full weight-bearing; reassess in 3 months as this is still within expected healing time
• C Dynamisation of the nail by removing the distal locking screws ✓
• D Surgical intervention with bone grafting is mandatory at this stage

Explanation

Delayed union (fracture not healed by expected time — typically 3–4 months for tibia) with a locked nail showing < 25% cortical bridging can be managed by dynamisation — removal of distal interlocking screws converts the static locked nail to a dynamic mode, allowing axial micromotion and compressive forces across the fracture that stimulate callus formation. This is appropriate when the nail is in good position. Exchange nailing is reserved for atrophic or established non-union with inadequate nail size.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.