Hypertrophic non-union of a tibial shaft fracture (with radiological callus present but failure to bridge) indicates that the fracture site has adequate biology but inadequate mechanical stability. The principle underlying the treatment choice is:

• A Bone grafting is mandatory because hypertrophic non-union is biologically deficient
• B BMP application is the first-line treatment
• C Mechanical stabilisation (rigid fixation — exchange nailing or compression plating) is the primary intervention; bone graft is usually NOT required ✓
• D Amputation is the recommended management for tibial non-union

Explanation

Hypertrophic non-union has exuberant callus (elephant foot or horse hoof pattern) indicating robust biological potential — the fracture site is well-vascularised and has viable cells actively producing callus, but micro-motion prevents final bridging. Treatment is purely mechanical: providing rigid fixation (exchange intramedullary nailing with reaming, or compression plating) converts the unstable construct to a stable one, allowing the existing biology to complete ossification. Bone graft is not required and should not be added unless there is an associated bone defect or oligotrophic features. Atrophic non-union, by contrast, requires biological augmentation (bone graft, BMPs) alongside stabilisation.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.