A 32-year-old male presents 3 months after tibial shaft fracture with no bridging callus on X-ray and the fracture gap is well-vascularized on bone scan. The most appropriate treatment for this hypertrophic non-union is:

• A Autogenous bone grafting with plate fixation
• B Electrical bone stimulation alone
• C Improved mechanical stability with exchange intramedullary nailing (reaming + larger nail) ✓
• D BMP-2 injection into the fracture gap

Explanation

Hypertrophic non-union (elephant foot, horse hoof patterns) has adequate vascularity but inadequate mechanical stability — treatment requires improved fixation, not additional bone graft or biologics. Exchange nailing (removing the existing nail, reaming to a larger diameter, inserting a larger-diameter nail) simultaneously improves biomechanical stability and introduces osteoprogenitor cells via the reaming debris. It is the treatment of choice for hypertrophic tibial non-union after IM nailing. Atrophic non-union (avascular) requires both fixation AND bone grafting.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.