A 45-year-old man has delayed union of a tibial shaft fracture at 5 months. X-ray shows periosteal reaction and sclerotic fracture ends without a bridging callus. Which of the following best describes the radiological type of non-union present?
- A Hypertrophic non-union (elephant foot type) ✓
- B Oligotrophic non-union
- C Atrophic non-union
- D Pseudarthrosis
Correct answer: A. Hypertrophic non-union (elephant foot type)
Explanation
Hypertrophic (elephant foot) non-union is characterised by abundant periosteal callus, sclerotic reactive bone ends, and no bridging — indicating adequate vascularity but mechanical instability. Oligotrophic non-union has minimal callus and is usually due to poor reduction. Atrophic non-union has no callus, avascular bone ends, and indicates a biological failure. Pseudarthrosis has a synovial-like cavity between fragments. The periosteal reaction and sclerosis described are hallmarks of hypertrophic non-union.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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