Hypertrophic non-union of a tibial shaft fracture is BEST managed by:

• A Bone grafting with cast immobilisation
• B Exchange intramedullary nailing without bone graft ✓
• C Ilizarov ring fixator with bone graft
• D Locked plating with bone graft

Explanation

Hypertrophic non-union indicates biological capacity for healing but inadequate mechanical stability — the 'elephant foot' pattern on X-ray shows rich callus bridging. Exchange intramedullary nailing (reaming and inserting a larger nail) provides the required stability and stimulates endosteal healing through reamings; additional bone graft is not needed. Atrophic non-unions, lacking biology, require both stability AND bone grafting. Ilizarov fixation is reserved for infected or atrophic cases with bone loss.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.