A femoral shaft fracture is fixed with rigid compression plating achieving absolute stability. Which statement best describes the expected mode of bony union?

• A Endochondral ossification through a cartilaginous callus
• B Direct intramembranous remodelling by cutting cones crossing the fracture without callus ✓
• C Fibrous tissue differentiation followed by gradual mineralisation
• D Periosteal woven bone bridging the gap externally

Explanation

Absolute stability with interfragmentary compression produces strain low enough for primary or direct bone healing. Osteoclastic cutting cones tunnel directly across the fracture line, followed by angiogenesis and lamellar bone deposition, with no visible callus on X-ray. Callus-mediated endochondral healing is secondary healing seen with relative stability such as nails and bridges plates. Fibrous persistence would indicate delayed union, not planned healing.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.